Clinical characteristics of acute HSV-2 retinal necrosis

Tran, Thi Ha Chau; Stanescu, Dinu; Caspers-Velu, L; Rozenberg, Flore; Liesnard, Corinne; Gaudric, Alain; LeHoang, Phuc; Bodaghi, Bahram

doi:10.1016/j.ajo.2003.12.036

Cited by 81 publications

(51 citation statements)

References 37 publications

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“…Biological efficacy is achieved with 70 or 140 mg/kg of valacyclovir in rabbits (43), equivalent to approximately 5 g or 10 g daily for humans, i.e., 10-or 20-fold the usual 500-mg dosage of valacyclovir. Finally, our data add to previously reported clinical data (time for complete resolution of retinitis between 2 and 17 weeks [7,13,44], possible recurrence in the same eye despite ongoing antiviral treatment [44]) and biological data (presence of viral genome from 2 weeks to 6 months [20,33,40]) and strongly suggest that a more prolonged high-dose therapy (probably up to 50 days) could be considered for patients with ARN, especially those with VZV infection.…”

Section: Discussionsupporting

confidence: 76%

Time Profile of Viral DNA in Aqueous Humor Samples of Patients Treated for Varicella-Zoster Virus Acute Retinal Necrosis by Use of Quantitative Real-Time PCR

et al. 2013

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The objective of this study was to evaluate the kinetics of varicella-zoster virus (VZV) loads using quantitative PCR (qPCR) in patients treated for acute retinal necrosis (ARN). Six patients (52 ؎ 13 years old) with ARN syndrome were consecutively studied. Aqueous humor (AH) was sampled from both eyes of all patients for qPCR evaluation. The patients were treated with intravenous acyclovir and intravitreal injections of antiviral drugs. The mean follow-up time was 17.6 ؎ 16.4 months. Main outcome measures were the numbers of viral genome copies in the AH, assessed using real-time qPCR with hydrolysis probe technology with a threshold of detection of 200 copies/ml. Two main portions of the viral load curves were observed for each patient: a plateau phase (27.8 ؎ 24.9 days) and a decrease in the number of viral genome copies. The mean baseline viral load was 3.4 ؋ 10 7 ؎ 4.45 ؋ 10 7 copies/ml (6 ؋ 10 6 to 1.2 ؋ 10 8 copies/ml). The viral load decreased according to a logarithmic model, with a 50% reduction obtained in 3 ؎ 0.7 days. There was a significant viral load (>102 copies/ml) at 50 days after the onset of treatment, despite antiviral drugs. qPCR use demonstrated reproducible VZV DNA kinetics with a two-phase evolution: a plateau followed by a logarithmic decrease. These data suggest that high-dosage antiviral therapy administered for the conventional 10-day duration is insufficient for most patients. This series of patients responded with a similar decrease in viral load once treatment was initiated, and the data from these patients may be used to predict the responses of future patients. Acute retinal necrosis syndrome (ARN), one of the most serious infectious ocular diseases, is caused by herpesviruses, with varicella-zoster virus (VZV) being the most common (1, 2). Great advances have been made in the diagnosis of viral retinitis with the detection of viral DNA in intraocular fluids (vitreous and aqueous humor [AH]) and accurate quantification of viral genome copies using real-time quantitative PCR (qPCR) (3, 4).The extent of retinitis, such as anterior chamber and vitreous inflammation, vasculitis, retinal necrosis, and scarring of the involved retina, is currently monitored with physical examination. Vitreous opacities and/or cataract development, however, may preclude visualization of the posterior segment, making clinical monitoring and appraisal of the efficacy of antiviral treatment difficult. At this time, it is not known whether the kinetics of viral DNA during systemic treatment (i.e., acyclovir [5], valacyclovir [6,7], or famciclovir [6-8] and/or intravitreal therapy [9]) is similar in all patients and can be predicted once the treatment is initiated.The objective of this case series was to assess the evolution of VZV DNA loads after systemic/intravitreal antiviral treatment in ARN and to evaluate the contribution of qPCR to the monitoring of patients with VZV acute retinal necrosis. MATERIALS AND METHODSThis retrospective study was conducted in a tertiary center with a consecutive series of s...

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Section: Discussionsupporting

confidence: 76%

Time Profile of Viral DNA in Aqueous Humor Samples of Patients Treated for Varicella-Zoster Virus Acute Retinal Necrosis by Use of Quantitative Real-Time PCR

et al. 2013

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“…Intravenous and intravitreal ganciclovir has been used in case reports. 84,85 What remains to be elucidated is the exact duration of treatment. Clinical examination has been the gold standard in monitoring treatment response and dosage titration.…”

Section: Discussionmentioning

confidence: 99%

Antiviral selection in the management of acute retinal necrosis

Tam

Hooper²,

Lightman

2009

OPTH

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Abstract:There is no consensus on the optimal antiviral regimen in the management of acute retinal necrosis, a disease caused by herpetic viruses with devastating consequences for the eye. The current gold standard is based on retrospective case series. Because the incidence of disease is low, few well-designed, randomized trials have evaluated treatment dosage and duration. Newer oral antiviral agents are emerging as alternatives to high-dose intravenous acyclovir, avoiding the need for inpatient intravenous treatment. Drug resistance is uncommon but may also be difficult to identify. Antiviral drugs have few side effects, but special attention needs to be paid to patients who have underlying renal disease, are pregnant or are immunocompromised.

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“…O prognóstico é relativamente sombrio, tendo em vista que 60% dos pacientes apresentam acuidade visual final abaixo de 20/400, em conseqüência de descolamento de retina, neuropatia óptica isquêmica e periflebite oclusiva (1)(2)(3)(4) .…”

Section: Introductionunclassified

Necrose retiniana aguda por presumível etiologia viral por herpes simples resultando em endoftalmite: relato de caso

Tanaka¹,

Fonseca²,

Helal³

2011

Rev. bras.oftalmol.

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RESUMOA necrose retiniana aguda é uma rara e devastadora retinite necrotizante, que pode ser causada pelo vírus herpes simples tipo 1 ou 2. Afeta tipicamente pacientes saudáveis de todas as idades. Este estudo é um relato de caso de um paciente de 18 anos, previamente hígido, que apresentou necrose aguda de retina por presumível etiologia viral por herpes simples, e descreve sua apresentação clínica e ultrassonográfica. Por não ter sido diagnosticado e tratado precocemente, a necrose retiniana aguda cumpriu sua história natural e evoluiu para um quadro compatível com endoftalmite.

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Clinical characteristics of acute HSV-2 retinal necrosis

Cited by 81 publications

References 37 publications

Time Profile of Viral DNA in Aqueous Humor Samples of Patients Treated for Varicella-Zoster Virus Acute Retinal Necrosis by Use of Quantitative Real-Time PCR

Time Profile of Viral DNA in Aqueous Humor Samples of Patients Treated for Varicella-Zoster Virus Acute Retinal Necrosis by Use of Quantitative Real-Time PCR

Antiviral selection in the management of acute retinal necrosis

Necrose retiniana aguda por presumível etiologia viral por herpes simples resultando em endoftalmite: relato de caso

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