MYTHS AND TRUTHS OF THE ASSOCIATION OF RETINAL VASCULAR OCCLUSION WITH COVID-19.

PURPOSE: To critically review data published in the recent past to scrutinize a causal relationship between retinal vascular occlusion and COVID-19. METHOD: A comprehensive literature search was performed on Pubmed with the key words retinal vascular occlusion, retinal vein occlusion, retinal artery occlusion, and COVID-19. RESULTS: A total of 17 case reports were published during this period, and 10 were on retinal vein occlusion and 7 on retinal artery occlusion. Most of the published reports lacked convincing evidences in one or the other aspects, such as insufficient laboratory workup or presence of multiple confounding risk factors. CONCLUSION: In this index article, strength of the data is insufficient to establish a definitive cause-and-effect relationship of retinal vascular occlusive disorders with COVID-19. Hence, clinicians can continue to manage these cases according to the standard guidelines until there are more robust evidences to support this association to alter the diagnostic and treatment modalities.

Human Adenovirus: An Unusual Causative Agent for Acute Retinal Necrosis Presented with Central Retinal Vascular Occlusion.

PURPOSE: We describe a case of acute retinal necrosis (ARN) with central retinal vascular occlusion caused by human adenovirus (HAdV). CASE REPORT: A 41-year-old man presented with a sudden decrease of visual acuity in his right eye since seven days. Visual acuity was hand movements and ophthalmic examination of the right eye revealed diffuse hemorrhagic retinal vasculitis with panuveitis. He was clinically diagnosed as ARN with central retinal vascular occlusion. An anterior chamber paracentesis and intravitreal ganciclovir injection were performed and intravenous ganciclovir has been initiated immediately. Polymerase chain reaction (PCR) analysis of aqueous humor identified HAdV DNA as a causative agent. Oral prednisolone was added to treatment 5 days after antiviral therapy. After 10 days of intravenous ganciclovir therapy, oral valganciclovir was given for 6 months. No recurrence or retinal detachment occurred during follow-up. CONCLUSION: HAdV known to cause acute epibulbar infections of the eye may also cause intraocular inflammation such as ARN.

Combined central retinal artery and vein occlusion with optic perineuritis following herpes zoster dermatitis in an immunocompetent child.

A 15-year-old healthy boy developed acute, rapidly progressing visual loss in left eye following herpes zoster dermatitis, with a combined central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO), along with optic perineuritis. Laboratory tests were negative. Despite an empirical, intensive antiviral treatment with systemic corticosteroids, and vision could not be restored in the affected eye. Herpes zoster dermatitis, in an immunocompetent individual, may be associated with a combined CRAO and CRVO along with optic perineuritis, leading to profound visual loss.

Bilateral central retinal artery occlusion associated with herpes simplex virus-associated acute retinal necrosis and meningitis: case report and literature review.

A 60-year-old woman with a history of recurrent headaches and blurred vision presented with bilateral optic disc edema. Optic neuritis was suspected, and intravenous methylprednisonlone was administered. Her vision declined to hand motions in both eyes, and subsequent evaluation revealed bilateral acute retinal necrosis with bilateral central retinal artery occlusions (CRAO). Aqueous humor polymerase chain reaction analysis was positive for herpes simplex virus (HSV), establishing a diagnosis of HSV-associated bilateral acute retinal necrosis (ARN) and meningitis. CRAO has rarely been reported in association with ARN, and a fulminant course with bilateral CRAO in association with ARN has not been previously reported. This case emphasizes the importance of careful peripheral examination in patients with presumptive optic neuritis, judicious use of systemic corticosteroid in this context, and the retinal vaso-obliterative findings that may be observed in the pathogenesis of ARN.

Central retinal artery occlusion secondary to dengue fever.

Dengue fever is endemic in the tropics and subtropics and has become a worldwide health threat in recent years. Dengue-related ocular complications are increasingly being reported from countries in South-East Asia. The authors report the first documented case of a patient with dengue fever who developed central retinal artery occlusion in addition to many other eye complications such as severe ptosis and complete internal and external ophthalmoplegia during her convalescent phase. The disease was confirmed by specific serological tests. Despite treatment, severe visual impairment occurred in this case.

Optic neuropathy and central retinal vascular obstruction as initial manifestations of acute retinal necrosis.

BACKGROUND: The purpose of this brief communication is to alert ophthalmologists that optic neuropathy may herald acute retinal necrosis (ARN). CASE: A previously healthy 54-year-old man exhibited optic neuropathy as an initial presentation of ARN, 8 weeks after varicella-zoster dermatitis. OBSERVATIONS: Central retinal vascular obstruction developed subsequently in his left eye. Later, the classic presentation of ARN appeared in his contralateral eye. Systemic acyclovir therapy stopped the progression of retinitis and resulted in healing of retinal lesions in his right eye. CONCLUSIONS: This case suggests that optic neuropathy, especially with preceding herpetic dermatitis, should be suspected as the prodrome of ARN.

Multiple recurrent branch retinal artery occlusions associated with varicella zoster virus.

PURPOSE: The authors describe an immunocompetent patient who developed multiple recurrent branch retinal artery occlusions (BRAOs) associated with the varicella zoster virus (VZV). METHODS: A 69-year-old woman with mild bilateral vitritis developed superior and inferior BRAOs in her right eye with decreased visual acuity to 20/40, and a peripheral BRAO inferotemporally in her left eye. One month later, the inferotemporal BRAO progressed proximally in her left eye with a decrease of visual acuity to 20/40. After an extensive negative systemic evaluation, she underwent a diagnostic pars plana vitrectomy of her right eye. RESULTS: Vitreous fluid was positive for VZV DNA by polymerase chain reaction (PCR). The patient was treated with intravenous acyclovir and systemic oral steroids. After remaining disease free for 3 months, the patient had two recurrences: 1) a mild vitritis and 2) development of a new superior temporal artery occlusion in the left eye. Both recurrences were treated with oral acyclovir and systemic steroids. The patient remained recurrence free for 12 months on a maintenance dose of oral acyclovir, and for 4 additional months without acyclovir. CONCLUSIONS: Varicella zoster virus can be associated with the syndrome of multiple recurrent BRAOs. The diagnosis of VZV-associated BRAO can be established by PCR of intraocular fluid.