Chronic Retinal Necrosis

Schneider, Eric; Elner, Susan G.; Kuijk, Frederik J. van; Goldberg, Naomi R.; Lieberman, Ronni M.; Eliott, Dean; Johnson, Mark W.

doi:10.1097/iae.0b013e318285f486

Cited by 64 publications

(57 citation statements)

References 28 publications

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“…The causative agents are VZV, HSV-1, HSV-2, and rarely, CMV or Epstein–Barr virus 46,47. Data from a British registry reported an incidence of 0.5–0.63 patients/year of ARN, a number that remained fairly stable over the last decade and has been recently confirmed in a German survey 48,49.…”

Section: Herpes Virus-associated Posterior Uveitismentioning

confidence: 94%

Current aspects on the management of viral uveitis in immunocompetent individuals

Pleyer

Chee

2015

OPTH

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Viruses are a fundamental etiology of ocular inflammation, which may affect all structures of the organ. Advances in molecular diagnostics reveal an increasingly broader spectrum of virus-associated intraocular inflammation, including all members of the herpes family, rubella virus, and other more rare causes such as Epstein–Barr and chikungunya virus. In particular, viruses of the herpes family are important causes of anterior and posterior uveitis. Owing to their often fulminant clinical course and persistence in ocular tissues, a clear differential diagnosis between alpha- and beta-type herpes viruses is essential to guide acute and long-term treatment. Here, we review the epidemiology, clinical, and laboratory findings of virus-associated uveitis with emphasis on their therapy and management and include our own experience.

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Section: Herpes Virus-associated Posterior Uveitismentioning

confidence: 94%

Current aspects on the management of viral uveitis in immunocompetent individuals

Pleyer

Chee

2015

OPTH

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“…4,100,105,108,139,140,189,214 75%–85% of AIDS patients with CD4+ counts less than 50 cells/μL have CMV retinitis. 97,100,105,195,254 CMV retinitis is the most frequent manifestation of CMV disease among AIDS patients and accounts for 75%–85% of all CMV end-organ disease.…”

Section: Viral Posterior Uveitismentioning

confidence: 99%

“…108 Rarely, CMV retinitis may occur in immunocompetent individuals, although these patients usually have some degree of immune dysfunction, such as advanced age, diabetes mellitus, corticosteroid, and noncytotoxic immunosuppressive medication use. 214 …”

Section: Viral Posterior Uveitismentioning

confidence: 99%

“…Most patients are males. 4,100,105,108,140,189,214 CMV retinitis usually begins as a unilateral disease, but progresses to involve the contralateral eye within 6 months in about 20% of cases, presumably from hematogenous spread. 119,140 The disease follows a chronic clinical course.…”

Section: Viral Posterior Uveitismentioning

confidence: 99%

“…119,140 The disease follows a chronic clinical course. 214 The demographics and clinical characteristics of CMV retinitis can be found in Table 8. 4,100,105,108,140,189,214 …”

Section: Viral Posterior Uveitismentioning

confidence: 99%

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Viral posterior uveitis

Lee

Agarwal

Mahendradas

et al. 2017

Survey of Ophthalmology

103

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The causes of posterior uveitis can be divided into infectious, autoimmune, or masquerade syndromes. Viral infections, a significant cause of sight-threatening ocular diseases in the posterior segment, include human herpesviruses, measles, rubella, and arboviruses such as dengue, West Nile, and chikungunya virus. Viral posterior uveitis may occur as an isolated ocular disease in congenital or acquired infections or as part of a systemic viral illness. Many viruses remain latent in the infected host with a risk of reactivation that depends on various factors, including virulence and host immunity, age, and comorbidities. Although some viral illnesses are self-limiting and have a good visual prognosis, others, such as cytomegalovirus retinitis or acute retinal necrosis, may result in serious complications and profound vision loss. Since some of these infections may respond well to antiviral therapy, it is important to work up all cases of posterior uveitis to rule out an infectious etiology. We review the clinical features, diagnostic tools, treatment regimens, and long-term outcomes for each of these viral posterior uveitides.

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Subacute Vision Loss in a Patient With Limited Immune Dysfunction

2020

Self Cite

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A 62-year-old man presented with subacute, painless vision loss in the right eye that developed over the course of 1 week. He had a history of well-controlled type 2 diabetes and diffuse large B-cell lymphoma that was diagnosed 3 years earlier. The lymphoma was initially treated with chemotherapy, followed by a relapse that required additional chemotherapy and ultimately autologous bone marrow transplant 3 months before presentation. At the time of presentation, he was taking no immunosuppressive medications and was taking prophylactic acyclovir, 800 mg twice daily, and sulfamethoxazole/ trimethoprim (800 mg/1600 mg) 3 times weekly.Snellen visual acuity measured 20/40 OD and 20/20 OS. Intraocular pressure (IOP) measured 24 mm Hg OD and 12 mm Hg OS. There was no afferent pupillary defect. Right eye examination results revealed 1+ anterior chamber inflammation, iris neovascularization, keratic precipitates, vitritis, and a granular necrotizing retinitis (Figure , A). Left eye examination results were unremarkable. Fluorescein angiography of the right eye demonstrated panretinal occlusive vasculopathy with severe peripheral nonperfusion (Figure , B). His white blood cell count was moderately low at 3.1 kilos/μL (to convert to ×10 9 /L, multiply by 0.001; reference range, 4.0-10.0 kilos/μL); a complete blood count and serum chemistry panel were otherwise normal. Human immunodeficiency virus (HIV) testing results were negative. An aqueous tap was performed and sent for culture and polymerase chain reaction. A Wide-field fundus photograph B Late-phase fluorescein angiogram Clinical Review & Education

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Chronic Retinal Necrosis

Cited by 64 publications

References 28 publications

Current aspects on the management of viral uveitis in immunocompetent individuals

Current aspects on the management of viral uveitis in immunocompetent individuals

Viral posterior uveitis

Subacute Vision Loss in a Patient With Limited Immune Dysfunction

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