Objective To observe the clinical features of acute retinal necrosis syndrome (ARN).Methods The clinical data of 84 patients (98 eyes) with ARN were retrospective analyzed. The patietns had undergone the examinations of best visual acuity, intraocular pressure, Bscanning, slitlamp biomicroscope, preset lens, direct and (or) indirect ophthalmolscope,and trihedral reflector; fundus fluorecein angiography had been performed on the patients with clear refracting media. Some of the patients had undergone polymerase chain reaction (PCR) to dectet the types of the causative virus.Medication,laser photocoagulation,and vitreous surgery had been performed on the patients after the diagnosis was confirmed. The visual acuity and the change of ocular fundus had been followed up; the average followup was 24.1 months. Results The average age of the patients at the onset was 42.8 years with the bilateraleye rate of 16.6% and retinaldetachment rate of 57.1%. There were 53.5% and 35.5% patients had the final visual acuity of gt;0.02 after 6 and 12 months, respectively. Better prognosis was found in patients diagnosed within 2 weeks and second involved eye. Varicella zoster virus DNA was identified in 15 patients and herpes simplex virus 1 was found in 3.Conclusions ARN is an acute disease with high incidence of retinal detachment.Serious retinal vasculopathy always happens at the late stage, and the prognosis is poor. Diagnosis in early stage is important and application of PCR will do contribution to the right diagnosis.
Objective To evaluate the clinical features and treatment outcomes of acute retinal necrosis syndrome (ARNS) which caused by long-term usage of immunosuppressent drug. Methods The clinical data of 8 patients (12 eyes) with immunocompromised-related ARNS were retrospectively reviewed. The diagosis was made by medical history, slit-lamp microscopy, pre-set lenses check, serologic examination and fluorescein fundus angiography. The patients (2 males and 6 females) aged from 35 to 54 years, with the mean age of 44.2 years. Previous medical history included hematopathy (2 cases), thymus tumor (2 cases, one also with meningoencephalitis), meningoencephalitis (2 cases), systemic lupus erythematosus (1 case) and acute pneumonia (1 case). All patients received immunosuppressent therapy for a long time before ARNS occurred. The visual acuity was ＜0.05 (5 eyes, 41.7%), or 0.05-0.3 (3 eyes, 25.0%), or 0.3-1.0 (4 eyes, 33.3%). Those ARNS patients received antiviral therapy, laser photocoagulation and (or) surgery therapy. The mean followed-up period was 10.8 months (from 3 to 36 months). Results The eye sympotoms and uveitis of all patients were very mild, and their retinal vasculitis and retinal necrosis progressed slowly. Retinal vasculitis was involved in 4 quadrants (7 eyes), or 1-2 quadrants (2 eyes), or ＜1quadrant (3 eyes). Retinal necrosis extended from peripheral retina to mid- peripheral retina (10 eyes, 83.4%), or from peripheral retina to posterior pole (2 eyes, 16.6%). At the end of the follow-up period, the visual acuity of 7 eyes (58.3%) showed different degree of improvement. The follow-up visual acuity was ＜0.05 (4 eyes, 33.3%), or 0.05-0.3 (2 eyes, 16.6%), or 0.3-1.0 (6 eyes, 50%). Conclusions Immunocompromised ARNS patients had valid medical history and typical clinical features. However the eye sympotoms and uveitis were very mild, retinal vasculitis and retinal necrosis progressed slowly in this study. Early diagnosis and prompt therapy may save the visual acuity of those patients.
Objective To observe the therapeutic effects of ganciclovir (GCV) with different injection methods on experimental acute retinal necrosis (ARN). Methods The right eyes of 41 pigmented rabbits were infected by herpes simplex virus (HSV-1) (COS strain) to establish ARN animal model. After 24 and 72 hours, GCV was given by intravitreal injection (10 eyes), intravenous injection (11 eyes) and the intravitreal+intravenous injection (10 eyes); intravitreal injection of GCV and dexamethasone (6 eyes) was also included. Four eyes were not treated as the control. The dosage of GCV in intravitreal and intravenous injection was 800mu;g and 5mg/kg weight, respectively. Retina necrosis was observed and the grade was recorded 1-21 days after injection according to the grade standard of retinopathy. The maximum grades of retinal necrosis in different groups were compared. Results The grade of retinal necosis was 3.8 in the control group, and 0.2, 0.4, 0.8, and 2.2 in intravitreal injection, intravitreal+intravenous injection, intravitreal injection with GCV and dexamethasone, and intravenous injection, respectively, 24 hours after the model was set up. The effects of the first 3 groups were obviously better than the last group (P=0.003, 0.011, 0.045); while the difference among the first 3 groups were not significant (P=0.881、0.054、0.107). Seventy-two hours after the model was set up, the grades of retinal necrosis were above 1.4 in 4 groups, and the differences among the 4 groups were not apparent (P=0.214). Conclusions In the animal model of ARN, intravitreal injection with GCV can effectively decrease the grade of retinal necrosis. The difference among intravitreal injection, intravitreal+intravenous injection, intravitreal injection with GCV and dexamethasone, and intravenous injection is not significant.
ObjectiveTo observe the changes of varicella zoster virus (VZV)-DNA load in aqueous humour samples in VZV-induced acute retinal necrosis (ARN) in the early stages of antiviral treatment. MethodsA retrospective observational clinical study. From April 2016 to April 2018, 24 patients with 24 eyes of VZV-induced ARN who were diagnosed by Department of Ophthalmology, Eye and ENT Hospital of Fudan University and received complete aqueous humor sampling were included in the study. Among them, there were 13 males with 13 eyes, 11 females with 11 eyes; 12 left eyes and 12 right eyes; the age was 52.0±9.5 years old (39-71 years old). The time from the onset of ocular symptoms to the diagnosis of ARN was 16.6±6.1 days (7-30 days). Best-corrected visual acuity (BCVA) and ultra-wide-field fundus imaging were performed in all affected eyes. The BCVA examination was carried out using the Snellen visual acuity chart, which was converted into the logarithm of the minimum angle of resolution (logMAR) visual acuity. All patients were given intravitreal injection of 40 mg/ml ganciclovir 0.1 ml (including 4 mg of ganciclovir), 2 times a week, until the active necrotizing retinal lesions subsided, at most after the diagnosis 4 weeks, with a maximum of 9 injections. The follow-up period was 12.8±5.6 months. The aqueous humor samples were collected at presentation and 4, 7, 14, 21, 28 days after the initiation of antiviral therapy, and the VZV-DNA load was detected by real-time quantitative polymerase chain reaction. A plateau phase and a logarithmic reduction phase of the DNA load changes were observed after antiviral treatment began. Wilcoxon rank sum test was used to compare and analyze the differences in BCVA between the eyes at baseline and last follow-up. ResultsThe mean viral load at presentation was 8.6×107±1.3×108 copies/ml. The initial plateau phase last for an average of 7.4±2.4 days. In the following logarithmic reduction phase, the mean slope of the decline in viral load was －0.13±0.04 log/day, and the expected time for half reduction of the initial viral load was 2.5±0.7 days. After 28 days antiviral treatment, the viral load decreased to 1.7×105±1.8×105 copies/ml. In the course of the disease, rhegmatogenous retinal detachment occurred in 16 eyes. Before treatment and at the last follow-up, the logMAR BCVA of the affected eye was 1.1±0.6 and 0.8±0.7, respectively. The results of correlation analysis showed that the logMAR BCVA at the last follow-up was correlated with the initial VZV-DNA load (r=0.467, P=0.033). ConclusionThe VZV-DNA load in the aqueous humor of eyes with VZV-induced ARN is significantly decreased after antiviral treatment, which is closely related to the clinical process of ARN.