Surgical repair of retinal detachment associated with viral retinitis
A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha in Vitreoretinal Surgical Techniques, 2019
Acute retinal necrosis, in contrast to CMV retinitis, classically occurs in immunocompetent patients. Patients present with a triad of posterior segment findings: retinal and choroidal vasculitis, retinal necrosis, and vitritis.24 There is a predilection for the retinal necrosis to involve initially the peripheral retina, with spread to the macula occurring as a late finding. The patches of peripheral retinal necrosis eventually coalesce into broad geographic areas. Vitritis is such a consistent feature of ARN that, in its absence, the diagnosis is suspect. ARN can typically be differentiated from CMV retinitis on the basis of the above-mentioned clinical characteristics, as well as from immune status. When ARN occurs in AIDS patients, the differentiation between the two entities may be more difficult, but ARN patients with AIDS typically have CD4 counts greater than 60 cells/μl and most have a preceding history of dermatomal herpes zoster or herpes simplex dermatitis.22
Vitreoretinal Surgery in Rare Conditions
Pradeep Venkatesh in Handbook of Vitreoretinal Surgery, 2023
Acute retinal necrosis syndrome is a rare disease caused by one of the neurotropic human herpes viruses: herpes simplex virus (type 1 or 2), varicella-zoster virus, or Epstein-Barr virus. The American Uveitis Society criteria for diagnosing acute retinal necrosis include focal, well-demarcated, peripheral areas of retinal necrosis; rapid circumferential progression; occlusive vasculopathy with arteriolar involvement; and a prominent inflammatory reaction in the vitreous and anterior chamber. The diagnosis of acute retinal necrosis syndrome is clinical, and the presence of optic neuropathy, scleritis, and pain supports the diagnosis. Immunological status of the patient [immunocompetent or immunodeficient] does not influence the clinical diagnosis of acute retinal necrosis syndrome. The fellow eye becomes involved in about 36% of patients with acute retinal necrosis, usually within 6 weeks of involvement of the first eye. Initial treatment is with intravenous acyclovir or oral valaciclovir, followed a few days later with addition of oral corticosteroids. Intravitreal anti-viral therapy may be helpful in arresting the disease earlier [but bilateral injection must be avoided]. Despite treatment, almost 75% of patients develop retinal detachment in the resolving phase [6–8 weeks]. Detachment results from the formation of multiple breaks at the junction of the necrotic and viable retina. Sieve-like breaks are characteristic and tend to coalesce at surgery. PVD is generally absent, but forceful attempts at creating one during surgery could result in iatrogenic complications. Prophylactic barrage laser was earlier believed to reduce the risk of developing vision-threatening retinal detachment. This has now been discontinued owing to the lack of evidence. The role of early vitrectomy, too, lacks clarity.
Case 13: Loss of Vision and a Maculopapular Rash
Layne Kerry, Janice Rymer in 100 Diagnostic Dilemmas in Clinical Medicine, 2017
The ophthalmology team reviewed the patient immediately and noted fine, keratic precipitates on the right cornea and 2+ cells in the anterior chamber. Fundal examination (see Figure 13.1) was obscured by significant vitritis and haze. There were white chorioretinal lesions and granular vitreal precipitates. The findings were consistent with right pan-uveitis with retinitis. The consultant reviewed and diagnosed acute retinal necrosis, possibly secondary to varicella-zoster virus (VZV) or herpes simplex virus (HSV). The patient commenced intravenous aciclovir.
Glaucoma Mimickers: A major review of causes, diagnostic evaluation, and recommendations
Published in Seminars in Ophthalmology, 2021
Sirisha Senthil, Mamata Nakka, Virender Sachdeva, Shaveta Goyal, Nibedita Sahoo, Nikhil Choudhari
Retinitis pigmentosa: With the progression of retinitis pigmentosa, the peripheral field defects enlarge and initially appear as biarcuate defects, and later manifest as a tubular fieldPan-retinal photocoagulation: Extensive pan-retinal photocoagulation for retinal conditions can result in biarcuate defects that mimic glaucoma.Acute retinal necrosis: The residual retinal scar following acute retinal necrosis or associated retinal detachment in these eyes can result in visual field defects that mimic glaucoma.
Treatment of Refractory Acute Retinal Necrosis with Intravenous Foscarnet or Cidofovir
Published in Ocular Immunology and Inflammation, 2018
Tomasz P. Stryjewski, Nathan L. Scott, Miriam B. Barshak, Ellis H. Tobin, Joshua O. Mali, Lucy H. Young, C. Stephen Foster, Ivana K. Kim, Marlene L. Durand
Acute retinal necrosis is an ophthalmologic emergency with poor visual outcomes in over 50% of affected eyes despite conventional therapy.2 Retinal detachment (as occurred in cases 3 and 4) is common and contributes to poor outcomes. Although most patients present with unilateral ARN, 3–15% develop fellow eye involvement despite IV acyclovir or valacyclovir.3,4 This rate was much higher (30–70%) in the pre-acyclovir treatment era.5,6 Some cases develop second eye involvement within 2 months of initial presentation and while still on antiviral therapy, as in cases 2 and 3, but others develop second eye involvement years later, as in case 1.2,6,7 Whether chronic antiviral prophylaxis will decrease the incidence of second eye involvement or prevent a recurrence of ARN in either eye is unknown. Most reported cases of late-onset (years later) ARN recurrences have occurred long after antiviral therapy for the initial ARN episode has finished, rather than while on prolonged antiviral prophylaxis as in case 1.
Acute Retinal Necrosis as a presenting ophthalmic manifestation in COVID 19 recovered patients
Published in Ocular Immunology and Inflammation, 2021
Aniruddh Soni, Raja Narayanan, Mudit Tyagi, Akash Belenje, Soumyava Basu
COVID-19 infection is also associated with biological and clinical markers of acquired immunosuppression such as lymphopenia, eosinopenia, and multiorgan failure, thus resulting in a dysfunctional immune response to the infectious agent.3–7 This state of immunodeficiency and immune dysregulation can result in reactivation of Herpesviridae virus.5–7 Acute retinal necrosis is a bilateral granulomatous panuveitis which is caused by a human herpes virus infection.8,9 Herei, we describe two patients who had recovered from COVID-19 and presented with a typical clinical picture of ARN with dense vitritis and necrotizing retinitis. The vitreous samples from both the patients tested positive for HSV-1 by RT-PCR. This report supports that COVID-19 can result in an immune dysregulated state thereby leading to reactivation of Herpes viruses and subsequently leading to ARN. The study was approved by the ethics committee of LV Prasad Eye Institute (LEC-BHR-R-12-26-563).
Related Knowledge Centers
- Arteritis
- Herpes Simplex Virus
- Herpesviridae
- Inflammation
- Necrosis
- Retinal Detachment
- Varicella Zoster Virus
- Retinitis
- Epstein–Barr Virus
- Chorioretinitis