Acute retinal necrosis with varicella zoster dermatitis in the fellow eyelid]

BACKGROUND: We report a case of acute retinal necrosis with contralateral varicella zoster dermatitis. CASE: The patient, a 61-year-old man, developed acute retinal necrosis in the right eye 1 month after varicella zoster dermatitis in the left eyelid. PROGRESS: Intravenous acyclovir, corticosteroids, and laser photocoagulation were effective without any surgical treatment. CONCLUSION: We suggest that ophthalmoscopic examination of both eyes is needed in cases with varicella zoster dermatitis.     

Acute retinal necrosis syndrome following herpes zoster dermatitis

The acute retinal necrosis (ARN) syndrome has been recently linked to intraocular infection with one or more members of the herpesvirus family. The authors report two cases of ARN following herpes zoster skin eruptions, and one case following ipsilateral facial nerve palsy (Ramsay Hunt syndrome). Evaluation of serial serum antibody titers against cytomegalovirus (CMV), herpes simplex virus (HSV) (types 1 and 2), and varicella zoster (VZ) virus revealed diagnostic changes for VZ virus alone following the retinitis. Immune precipitation of radiolabeled VZ proteins by these sera followed by gel fractionation yielded radioimmune precipitation profiles characteristic of a recent zoster reactivation. These cases further implicate a central role for VZ virus infection in the etiology of the ARN syndrome.     

Unilateral varicella zoster virus ophthalmicus and contralateral acute retinal necrosis

We report two patients who developed varicella zoster virus (VZV) ophthalmicus complicated by ipsilateral keratouveitis, and within 4 weeks developed acute retinal necrosis (ARN) in the contralateral eye. The ipsilateral retina was spared in each case. One patient had systemic lupus erythematosus (SLE) and the other Hodgkin's disease. Both patients were in remission at the time of presentation.     

Variable R1 region in varicella zoster virus in fulminant type of acute retinal necrosis syndrome

BACKGROUND/AIMS: Varicella zoster virus (VZV) is a causative agent in acute retinal necrosis (ARN) syndrome. However, in spite of aggressive antiviral therapy, clinical characteristics among patients have varied. Different viral strains were examined to determine their respective role in producing clinical characteristics. The viral strains were also compared with those of previously reported ones. METHODS: To differentiate VZV strains R1 and R5, variable regions of VZV were amplified by nested polymerase chain reaction (PCR) in 11 eyes of 10 patients. Sequence analysis was also performed. RESULTS: Four cases had strains diverted only at the tip of the 3' end of the R1 variable region, similar to that of the H-N3 strain, which was previously reported. Conversely, other cases were diverted to other regions. Interestingly, some of the latter cases showed multiple PCR products in the R1 region that were generated by the truncation of either the 5' or 3' R1 region. Final visual acuities of these patients were less than 0.2. The former cases showed final visual acuities more than 0.4. Only two variants were from the R5 region. No patient had the same viral strain as the European Dumas type. CONCLUSION: These results showed that variable VZV strains participated in ARN. Using PCR of the R1 variable region, it was estimated that patients with a more fulminant type of ARN may have diverse viruses with extensive replication in the affected eyes.     

Association of progressive outer retinal necrosis and varicella zoster encephalitis in a patient with AIDS.

BACKGROUND: A patient with AIDS who developed the clinical picture of bilateral progressive outer retinal necrosis (PORN) in combination with varicella zoster encephalitis is described. The picture developed more than 2 years after an episode of ophthalmic zoster infection, and following intermittent exposure to oral acyclovir because of recurrent episodes of cutaneous herpes simplex infection. METHODS: Aqueous humour, obtained by paracentesis of the anterior chamber, was analysed using immunofluorescence and polymerase chain reaction (PCR). Postmortem analysis of eye and brain tissue was performed by using conventional techniques and in situ hybridisation. RESULTS: While conventional techniques all failed to detect a causative agent, analysis of the aqueous humour using PCR, and histological examination of necropsy specimens from eyes and brain using in situ hybridisation were conclusive for the diagnosis varicella zoster virus (VZV) infection. CONCLUSION: This case documents the presumed association of PORN and VZV encephalitis in a severely immunocompromised AIDS patient.     

Association of herpetic encephalitis with acute retinal necrosis syndrome.

Bilateral acute retinal necrosis syndrome developed shortly after a severe acute encephalitis in two previously healthy adults. The clinical and laboratory data suggested that herpes simplex virus was the cause of the encephalitis and acute retinal necrosis in these patients. To the authors' knowledge, this is the first report of an association of herpetic encephalitis with acute retinal necrosis in the literature.     

Varicella zoster virus is a cause of the acute retinal necrosis syndrome

We studied two blind eyes enucleated during the active phase of the acute retinal necrosis syndrome. Both eyes showed similar histopathologic findings of necrotizing retinitis, retinal arteritis, and optic neuropathy. A virus morphologically consistent with a herpes group virus was found on electron microscopy and immunocytopathologic stains showed this virus to be varicella zoster in both cases. Varicella zoster virus was cultured from the vitreous of one of the eyes. We conclude that varicella zoster virus retinal infection is a cause of the acute retinal necrosis syndrome.     

Failure of sorivudine therapy in progressive outer retinal necrosis caused by varicella zoster virus

Background: We report on the case of a 23-year-old female who presented with ocular signs of progressive outer retinal necrosis (PORN) syndrome and who failed to respond to acyclovir, ganciclovir, foscamet and oral sorivudine. Methods: The patient was treated with the antiviral drugs acyclovir, ganciclovir, foscarnet and oral sorivudine. Results: The patient failed to respond to a combination of antiviral drugs. Unfortunately, progression of the retinitis occurred, which led to blindness. Conclusion: Despite new drugs, the prognosis of PORN is poor and recurrence is common.     

急性视网膜坏死综合征的治疗

急性视网膜坏死综合征( acute retinal necrosis syndrome, ARN)是一种主要由疱疹病毒引起的眼部疾病。该病发病机制尚不完全明确,病程进展快,治疗难度大,致盲率极高。目前主要的治疗方法是药物治疗与手术治疗相结合。常用的药物有抗病毒药物、糖皮质激素及抗血小板药物。手术治疗方法包括激光手术及玻璃体切割手术。     

急性视网膜坏死综合征的治疗

目的观察抗病毒药物联合玻璃体视网膜手术对急性视网膜坏死综合征(ARNS)的治疗效果。方法收集本院2006年3月至2011年3月急性视网膜坏死综合征病例23例(26只眼),全部在确诊初期起全身应用大剂量抗病毒药物治疗,其中17例(18只眼)发生增生性玻璃体视网膜病变(PVR)者行玻璃体切除+视网膜光凝+硅油填充术治疗,术后1年随访患者视力以及视网膜情况。结果 23例(26只眼)在治疗后视力均有不同程度的改善,16例(17只眼)行玻璃体视网膜手术1年后眼内炎症控制,视网膜平伏在位。结论早期全身大剂量使用抗病毒药物以及糖皮质激素联合玻璃体视网膜手术能显著减少ARNS患者视力严重丧失的发生率。     

Chickenpox-associated acute retinal necrosis syndrome.

Acute retinal necrosis (ARN) syndrome usually occurs as the result of secondary reactivation of latent, previously acquired, varicella-zoster or herpes simplex virus. The authors report four patients who developed a mild form of ARN within 1 month (5 to 28 days) after the onset of chickenpox. In contrast to typical cases of ARN, these cases were less severe, with retinitis limited to two quadrants or less (three patients), no retinal detachment (four patients), minimal vitreitis (four patients), and no loss of visual acuity (four patients). Thus, ARN may occur during the course of primary varicella-zoster infection.     

玻璃体切除术治疗急性视网膜坏死综合征

目的 探讨玻璃体切除术治疗急性视网膜坏死综合征的手术时机、手术方法并评价其疗效.方法 选取2005年1月至2008年6月经玻璃体切除术治疗急性视网膜坏死综合征的26例31只眼.单眼21例,双眼5例.自发病至手术时间为半个月至6个月.所有患者均给予无环鸟苷及糖皮质激素治疗,对于药物治疗病情无好转或就诊时已有严重的玻璃体混浊或已并发视网膜脱离患者,及时进行玻璃体切除手术.术中彻底切除混浊的玻璃体,包括用巩膜顶压法或在全视网膜镜下切除基底部玻璃体,对于视网膜表面的较厚渗出物用笛针仔细予以吸除,仔细剥离、切除视网膜前增殖膜,对于有视网膜脱离者注入重水压平视网膜,光凝封闭视网膜裂孔及坏死萎缩的视网膜区,气液交换后行C2F6、C3F8或硅油填充玻璃体腔.硅油填充眼视眼部情况择期行硅油取出术.观察炎症控制情况及视网膜复位、视力恢复情况.随访期为6个月至2年.结果 随访期间所有病例炎症均控制良好,单眼发病患者对侧眼未出现发病.25只眼(80.65%)视力有不同程度改善,其中18只眼视力≥0.1,占58.06%,最好视力为1.0.视网膜完全复位者28只眼,占90.32%;视网膜部分复位、硅油维持眼2只眼;低眼压、硅油维持眼1只眼.结论 对于急性视网膜坏死病情严重者,选择合适的手术时机、及时进行玻璃体切除手术治疗,可有效控制病情发展、挽救患者的视功能.     

玻璃体切除术治疗急性视网膜坏死综合征

目的：评价玻璃体切除术治疗急性视网膜坏死综合征（ARNS）的疗效。方法：对6例（7眼）伴有视网膜裂孔或脱离的ARNS患者进行玻璃体切除术,采用三通道睫状体平坦部切口切除玻璃体、剥膜、松解性视网膜切开、硅油填充及眼内光凝。术后半年到9个月取出硅油。结果：5眼伴有视网膜脱离眼手术治疗后视网膜均获得满意复位,2眼在取出硅油后视网膜脱离复发。2眼存在视网膜裂孔眼术后无新裂孔及视网膜脱离发生,所有病例术后视力均有不同程度改善,最优者为0.1。结论：玻璃体切除术是治疗急性视网膜坏死综合征有效的方法,可明显改善其预后。     

急性视网膜坏死综合症的临床治疗

目的探讨急性视网膜坏死综合征(acuteretinalnecrosissyndrome,ARNS)的病因、临床表现和临床治疗方法。方法对2002年12月到2004年9月期间在本院收治的9例ARNS患者13眼均分别给予抗病毒药物治疗、眼底激光治疗及玻璃体视网膜手术治疗,术后1m～17m随访患者视力及视网膜复位情况。结果9例13眼ARNS患者除1例双眼患者本人放弃治疗外,术后视力均有不同程度提高,其余11眼中手动/10cm者2眼,数指/20cm～100cm者5眼,0.05者1眼,0.25者1眼,0.4者2眼,大多维持了有用视力;予以玻璃体视网膜手术联合眼底激光治疗的5例7眼及单纯予以眼底激光的3例4眼,均保持了视网膜平伏。结论ARNS是一种严重的致盲性眼病,但如能早期发现、正确诊断并给予正确有效的联合治疗,是能够使大部分患者得到治愈或好转,挽救有用视力的。     

急性视网膜坏死综合征的临床治疗

目的 探讨急性视网膜坏死综合征临床治疗方法.方法 对急性视网膜坏死综合征30例36眼分别进行抗病毒药物联合激光治疗,或进行玻璃体视网膜手术联合药物治疗.对于已并发视网膜脱离17眼和药物联合激光治疗病情不能控制的6眼,行玻璃体视网膜手术,观察视力和视网膜情况.结果 36眼视网膜完全复位,炎症均得到控制.除1眼术后视力仍为光感,35眼(97.22％)视力得到不同程度提高.数指6眼,0.01～0.04者l眼,0.05～0.1者11眼,0.12～0.25者7眼,0.3～0.6者7眼,0.7～1.0者3眼.1眼术后持续低眼压,1例2眼取出硅油后视网膜脱离复发,经再次硅油填充而愈.结论 急性视网膜坏死是严重的致盲性眼病,视网膜脱离是其常见的并发症之一.早期诊断和及时足量的阿昔洛韦和皮质类固醇联合光凝,玻璃体视网膜手术均为治疗急性视网膜坏死综合征,保护视功能的有效方法.