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Infections
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Ocular toxoplasmosis occurs after congenital toxoplasmosis, or as a reactivation in immunocompromised hosts. The retina and choroid are mainly involved, causing blurred vision and pain. There is acute retinal necrosis.
Viral infections
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Herpes zoster ophthalmicus involves the ophthalmic division of the trigeminal nerve and occurs in up to 20% of patients with herpes zoster. Hutchinson sign is the appearance of a herpes zoster lesion on the tip or side of the nose and serves as a useful prognostic factor in the ensuing ocular inflammation. Clinically, patients develop lesions on the margin of the eyelid. Early complications include periorbital edema, residual ptosis, lid scarring, deep scalp pitting, entropion, ectropion, pigmentary changes, and lid necrosis [13]. Glaucoma, optic neuritis, encephalitis, hemiplegia, and acute retinal necrosis are more severe long-term complications, the risk of which may be reduced by half with prompt initiation of antiviral therapy. Chronic disease due to neurologic damage occurs in up to 30% of patients with this form of herpes zoster.
Posterior uveitis
Published in Gwyn Samuel Williams, Mark Westcott, Carlos Pavesio, Bushra Thajudeen, Practical Uveitis, 2017
Gwyn Samuel Williams, Mark Westcott
If extensive white patches of retina are seen in an acute setting the diagnosis must be acute retinal necrosis until proven otherwise. The intraocular pressure is an important clue directing the ophthalmologist to a potentially sight-threatening cause of posterior uveitis as toxoplasmosis characteristically presents in the acute phase with a raised intraocular pressure due to concurrent trabeculitis preventing egress of fluid from the eye, while acute retinal necrosis is typically normotensive.
Tocilizumab and Aflibercept as a Treatment Option for Refractory Macular Edema after Acute Retinal Necrosis
Published in Ocular Immunology and Inflammation, 2023
Alexandra Bograd, Peter M. Villiger, Marion R. Munk, Isabel Bolt, Christoph Tappeiner
Acute retinal necrosis (ARN) is caused by ocular infection with herpetic viruses as varicella zoster virus (VZV), herpes simplex virus, cytomegalovirus or Epstein-Barr virus. Severe complications as retinal detachment, optic nerve atrophy, or neovascularization may occur in patients with ARN and bear a high risk for irreversible vision loss.1 The inflammatory milieu may also lead to a breakdown of the inner and outer blood–retinal barrier and consequently to a cystoid macular edema (CME) with accumulation of intra- and subretinal fluid.2 Up to now there is no established therapeutic approach for CME in ARN patients. Case reports about successful treatments with interferon alpha-2a and intravitreal application of anti-vascular endothelial growth factor (VEGF) drugs have been published.3,4
Clinical Spectrum of Uveitis Induced by Herpes Simplex Virus with Posterior Pole Involvement at Initial Presentation: A Case Series and Literature Review
Published in Ocular Immunology and Inflammation, 2022
Feng Hu, Haicheng She, Xusheng Cao, Jiawei Wang, Caixia Lin, Xiaoyan Peng
One week later, the fundus could not be observed in the left eye due to severe vitritis. A diagnosis of acute retinal necrosis was made due to the results of the aqueous humor test. The patient received intravitreal ganciclovir (2 mg/0.1 mL) injections twice weekly for 2 weeks, as well as intravenous ganciclovir followed by oral ganciclovir for 3 months. Oral prednisolone at 1 mg/kg/day was given 4 days after antiviral therapy and tapered gradually. The ocular pain and pain upon eye movement alleviated 3 days later with intravitreal ganciclovir and systemic antiviral therapy, but her visual acuity did not improve. Necrotic lesions in the superior peripheral retina were observed after the second intravitreal ganciclovir injection. One month later, the patient underwent pars plana vitrectomy and silicone oil tamponade due to rhegmatogenous retinal detachment. During surgery, the finding of widely peripheral retinal necrosis involving four quadrants also supported the diagnosis of ARN. The visual acuity was hand movement 1 month after surgery. The optic disc was pale with wide occlusion of retinal vessels in the left eye.
Acute Unilateral Central Serous Chorioretinopathy after Immunization with Pfizer-BioNTech COVID-19 Vaccine: A Case Report and Literature Review
Published in Seminars in Ophthalmology, 2022
Palaniraj Rama Raj, Paul A Adler, Rajeev Chalasani, Sue Ling Wan
Atas et al. reported unilateral acute posterior multifocal placoid pigment epitheliopathy (APMPPE) in a 45-year-old female with the onset of visual symptoms occurring 1 week after the first dose of the Pfizer–BioNTech COVID-19 vaccine.50 No treatment was administered with complete resolution of subretinal fluid and placoid lesions observed after 5 weeks. Iwai et al. reported a case of unilateral acute retinal necrosis (ARN) with varicella zoster virus reactivation in a healthy 78-year-old-male, occurring two days after the first dose of the Pfizer–BioNTech COVID-19 vaccine.51 Diagnostic and therapeutic vitrectomy was performed in addition to systemic acyclovir and corticosteroids, with the best corrected visual acuity (BCVA) improving from 20/200 to 20/50. The patient, however, opted to receive the second dose of the Pfizer–BioNTech COVID-19 vaccine nine days after the initial vitrectomy, resulting in a recurrence of ARN complicated by total retinal detachment. Following a second vitrectomy and a prolonged course of systemic acyclovir and corticosteroids, BCVA stabilized from hand-motion to 20/100.51