Acute Retinal Necrosis: Virological Features Using Quantitative Polymerase Chain Reaction, Therapeutic Management, and Clinical Outcomes

Nian

International Journal of Infectious Diseases

et al. 2019

We report the case of a patient who presented with viral encephalitis and a pulmonary infection complicated with bilateral acute retinal necrosis after direct contact with diseased swine. Nextgeneration sequencing of the cerebrospinal fluid and vitreous humor detected pseudorabies virus (PRV) simultaneously. Intravenous acyclovir and dexamethasone treatment improved the symptoms of encephalitis, and vitrectomy surgery with silicone oil tamponade was used to treat the retinal detachment. This case implies that PRV can infect humans; thus, self-protection is imperative when there is contact with animals.

Section: Discussionmentioning

confidence: 99%

Human encephalitis complicated with bilateral acute retinal necrosis associated with pseudorabies virus infection: A case report

Nian

International Journal of Infectious Diseases

et al. 2019

European Journal of Ophthalmology

“…The effectiveness of this mode of treatment for ARN has been reported, previously. [32][33][34][35] The median time of diagnosis delay was 3 weeks (range 1-10 weeks) in our series. Of note, there was a substantial diagnosis delay in HSV-positive patients.…”

Section: Discussionmentioning

confidence: 99%

Acute retinal necrosis: Clinical manifestation and long-term visual outcomes in a series of polymerase chain reaction–positive patients

Hedayatfar

Ebrahimiadib

Zarei

et al. 2020

Purpose: To report the clinical spectrum, viral etiologies, therapeutic interventions, timing of rhegmatogenous retinal detachments (RRD), and visual outcomes in acute retinal necrosis (ARN) syndrome in a series of polymerase chain reaction (PCR)-positive eyes. Methods: From January 2010 to January 2017, consecutive patients with the clinical diagnosis of ARN and a positive aqueous viral PCR were included in this observational, retrospective study. Results: Nineteen eyes found to have a clinical diagnosis of ARN, of which 18 (94.7%) had a positive viral PCR. ARN was unilateral, except in one patient. None of the fellow eyes manifested ARN during follow-up. Varicella-zoster virus (VZV) was detected in 78.0% of ARN eyes. 61.1% of eyes experienced RRD. The median time for the occurrence of RRD was 12 weeks (range: 6–25 weeks) after disease onset. No correlation was found between the etiologic viral agent (VZV vs non-VZV; p = 1.000), extent of retinitis (1–2 quadrant vs 3–4 quadrants; p = 0.326), administration of intravitreal ganciclovir (injected vs not injected; p = 0.332), application of prophylactic laser retinopexy (applied vs not applied; p = 0.326), and subsequent occurrence of RRD. At a 2-year follow-up, visual impairment (VA ⩽ 20/200) and severe visual loss (VA ⩽ light perception) were significantly higher in those complicated by RRD compared to non-RRD eyes (81.8% vs 28.6%; p = 0.047, and 45.4% vs 0.0%; p = 0.004, respectively). Conclusion: Aqueous PCR results are highly consistent with the clinical diagnosis of ARN. Regardless of the method of management, the rate of RRD is high and is associated with a poor visual outcome.

“…So, diagnostic testing of vitreous humor before antiviral treatment has been done, and later corresponding adjustments were made. Topical and systemic antiviral treatment is an urgent need, as it is beneficial for the visual acuity and thus could decrease the risk of infection to the other eye [16]. As documented previously, there were up to 70% of untreated patients with bilateral ARN [17].…”

Section: Discussionmentioning

confidence: 84%

Herpes simplex virus type 1 related acute retinal necrosis following an encephalitis illness: a case report

Zhong

Zang

et al. 2021

BMC Neurol

Background Virus encephalitis is found to be a risk factor for acute retinal necrosis (ARN). Case presentation We herein presented a case of a 20-year-old teenage boy who suffered from encephalitis of unknown etiology with early negative pathologic results, and was primarily treated with systemic administration of high-dose steroids without antiviral therapy. He later had sudden vision loss in his right eye. Intravitreal and intravenous antiviral treatments were immediately started due to suspected ARN. Herpes simplex virus (HSV)-1 was identified later in the vitreous humor of the patient. After the surgery of retinal detachment (RD), obvious improvements in vision were observed. However, the patient had recurrent RD and vision declination 5 weeks later. Conclusions The case with suspected viral encephalitis should be treated with antiviral therapy regardless of early virologic results in order to avoid complications of a missed viral encephalitis diagnosis, especially if systemic steroid treatment is being considered.