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Treatment of Retinitis Induced by Cytomegalovirus Using Intravitreal Fomivirsen (ISIS 2922)
Published in Eric Wickstrom, Clinical Trials of Genetic Therapy with Antisense DNA and DNA Vectors, 2020
The most frequent and problematic manifestation of CMV infection in HIV-infected patients is CMV retinitis. Retinitis typically presents unilaterally, although as many as 35% of patients may have bilateral disease at presentation, and most develop bilateral disease (Heinemann, 1992). The disease is slowly progressive, may involve any part or all of the retina, and is necrotizing. It is often associated with significant inflammation and/or hemorrhage. Retinal detachment is common (up to 25% of patients). Although a number of drugs are available to treat CVM retinitis, none have been shown to cure the disease or to provide long-term disease control. All of the available agents are associated with significant toxicities.
Hunter disease/mucopolysaccharidosis type II/iduronate sulfatase deficiency
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
The voice is hoarse. Diarrhea may be a chronic problem; it may result from infiltration of the autonomic innervation of the intestine [23]. Retinitis pigmentosa may occur in this condition and retinal degeneration may cause blindness. Glaucoma may be a problem. Papilledema may be seen [24]; this is probably a consequence of pachymeningeal thickening, which may also lead to neurologic defects including quadriplegia from pressure on the cord [25]. It may also result in hydrocephalus [26]. Cerebral atrophy, which may also lead to ventricular enlargement, is seen regularly on computed tomography (CT) scan or magnetic resonance imaging (MRI) in severe Hunter disease [27–29], and there may be defective reabsorption of cerebrospinal fluid. Intracranial pressure may be increased.
Vitritis and Posterior Uveitis
Published in Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen, Practical Emergency Ophthalmology Handbook, 2019
An acute retinitis looks like an area of whitened retina with a fluffy border (see Figure 14.2). Look for any other lesions that might suggest previous inflammation, with areas of scarring typically appearing as areas of pigment which may be punched out or raised. Toxoplasmosis typically appears as an area of reactivated retinitis at the border of an area of scarring. The macula should then be examined for potential cystoid macular oedema (CMO).
Response to Comments on ‘Acute Bilateral Neuroretinitis and Panuveitis in A Patient with Coronavirus Disease 2019: A Case Report’
Published in Ocular Immunology and Inflammation, 2023
Seyedeh Maryam Hosseini, Arash Omidtabrizi
As Dr. Kawali and colleagues have mentioned, the signs and symptoms of our patient was substantially compatible with the diagnosis of epidemic retinitis. Although Iran is in an endemic region for the usual causes of epidemic retinitis, e.g. west Nile virus, our province, Khorasan Razavi has one of the least prevalence rates of seropositivity for these pathogens (including west Nile virus, Rift valley virus, rickettsia, etc.).2,3 We are working in a referral hospital for uveitis cases of the northeast of the country and we are facing a significant rise of the incidence of epidemic retinitis since the beginning of COVID-19 pandemics. A case series of these patients is under process for submission. Hence, we assume that COVID-19 can be listed as the new etiology of post-fever retinitis. We appreciate the hypothesis regarding co-infection or superinfection, however at that time COVID cases in our region presented with gastrointestinal disease in addition to other signs of COVID-19, so we are almost certain our case had no super or co-infection. We hope that with more reports of similar cases from around the world, knowledge regarding COVID-19 retinal manifestations will be more clarified. Finally, our main rationales for the association of ocular manifestations with COVID 19 in this case besides the history of systemic COVID-19 disease are the typic signs and symptoms, positive vitreous PCR result for COVID-19.
Epidemic Retinitis
Published in Ocular Immunology and Inflammation, 2019
Ankush Kawali, Padmamalini Mahendradas, Ashwin Mohan, Madhurya Mallavarapu, Bhujang Shetty
Uveitis post febrile illness has been described in many epidemics like Leptospirosis, Chickungunya, Dengue, West Nile Virus (WNV), Rickettsiosis and recently even in Ebola.1–6 Retinitis has been reported in many of these conditions.7,8 This retinitis is generally multifocal, cotton wool spot-like lesions localized in the posterior pole and around the disc and are associated with vitritis. Few of these outbreaks are known to repeat each year in tropical countries like India. Causative organism could be different for different epidemics but manifestation could be same in the form of retinitis. Systemic or local steroids are the mainstay therapy for these conditions. Seasonal variation, diverse etiologies and visual outcomes with different treatment modalities for retinitis post febrile illness (RpFI) has not been studied in a large cohort. Herein, we report demography, seasonal variation, clinical presentation, course of the disease and treatment outcomes of RpFI in our population.
Multiple Evanescent White Dot Syndrome Following Acute Epstein-Barr Virus Infection
Published in Ocular Immunology and Inflammation, 2019
Chang-Sue Yang, Ming-Hung Hsieh, Huan-I Su, Yih-Shiuan Kuo
EBV is a double-stranded DNA virus of the herpes family (human herpesvirus 4).19 The virus is transmitted through saliva and initially infects epithelial cells in the oropharynx and nasopharynx. EBV then enters the underlying tissues and infects the B lymphocyte. 20–22 The EB virus may either cause a lytic infection leading to cell death, or a nonproductive latent infection. We proposed two hypotheses regarding how EBV affects the eyes: the infectious or the autoimmune etiology. In Case No. 3, positive EB-VCA IgM antibody during the acute stage and preceding URI symptoms 1 week before MEWDS onset might suggest an infectious etiology. The virus may have directly caused the retinitis. We proposed that EBV-infected B cell may hematogenously travel to the retina by crossing the blood retina barrier (BRB) or by crossing the choriocapillaris and the retinal pigment epithelium (RPE) cell barrier. The epithelial cells may be the reservoir of infection. Tiedeman also suggested that the RPE cells may be the site for EB virus replication in patients of multifocal choroiditis.16 In the literature, positive Epstein-Barr virus capsid antigen (EB-VCA) antibodies were reported in 10 patients of multifocal choroiditis, compatible with recent or continuing Epstein-Barr virus infection.16 Raymond et al. also described punctate outer retinitis in a confirmed case of acute EBV infectious mononucleosis.23