Case Of Acute Retinal Necrosis Research Articles

Case of acute retinal necrosis with rapid progression to proliferative vitreoretinopathy: A case report.

Acute retinal necrosis (ARN) was first reported in 1971 by Urayama et al as an acute uveitis accompanied by retinal arteritis and white retinal lesions in the peripheral retina that can progress to a rhegmatogenous retinal detachment (RRD). We have experienced a case of ARN that, unlike the common developmental course to an RRD associated with ARN, progressed to proliferative vitreoretinopathy (PVR) involving the entire retina in 2 days. The purpose of this report is to present our findings in the case of ARN with an atypical rapid time course. The patient was a 56-year-old woman who was treated for uveitis of unknown origin by her primary care physician. She was referred to our hospital because of a worsening of the fundus findings. Fundus examination in our hospital revealed vitreous opacities in the right eye, yellowish-white lesions extending around the retina, and some retinal hemorrhages. Because the retinal changes suggested ARN, we performed a polymerase chain reaction of the anterior atrial fluid and detected varicella-zoster virus. Then, the diagnosis of ARN was confirmed, and treatment was begun. At 1 month and a half after beginning the treatment, focal retinal traction was observed in the right fundus. Two days later, a circumferential PVR and a total retinal detachment were detected. We then performed vitrectomy with an encircling buckle and a silicone oil tamponade. Our examination 6 months postoperatively showed that the retina was attached and the BCVA was 20/200. Our findings of a case of ARN showed that the progression from a local vitreous traction to a full circumferential PVR can develop in 2 days.

Acute Retinal Necrosis Associated with Pseudorabies Virus Infection: A Case Report and Literature Review

ABSTRACT Purpose To analyze a case of acute retinal necrosis (ARN) associated with pseudorabies virus (PRV) infection and discusses the clinical characteristics of PRV-induced ARN (PRV-ARN). Methods Case report and literature review of ocular features in PRV-ARN. Results A 52-year-old female diagnosed with encephalitis presented with bilateral vision loss, mild anterior uveitis, vitreous opacity, occlusive retinal vasculitis, and retinal detachment in her left eye. The result of metagenomic next-generation sequencing (mNGS) indicated that both cerebrospinal fluids and vitreous fluid tested positive for PRV. Conclusion PRV, a zoonosis, can infect both humans and mammals. Patients affected with PRV may experience severe encephalitis and oculopathy, and the infection has been associated with high mortality and disability. ARN is the most common ocular disease, which develops rapidly following encephalitis and is characterized by five figures: bilateral onset, rapid progression, severe visual impairment, poor response to systemic antiviral drugs, and an unfavorable prognosis.

Acute retinal necrosis in a patient on immunosuppressive treatment for COVID-19 pneumonia: a case report

BackgroundPatients with coronavirus disease 2019 (COVID-19) occasionally develop ocular complications. We report a case of acute retinal necrosis (ARN) caused by Epstein–Barr Virus (EBV) that developed in a patient who had severe acute respiratory syndrome due to SARS-CoV-2 infection.Case presentationA 68-year-old woman complained of floaters and blurred vision in her right eye as she was receiving systemic prednisolone for COVID-19 pneumonia under isolation in our hospital. The patient visited an ophthalmologist following her discharge from the hospital and after the 2 weeks of isolation had ended. At the initial examination, her best-corrected visual acuity (BCVA) was 20/100 in the right eye, and the eye showed moderate anterior segment inflammation and vitreous opacities. Treatment was initiated with topical 0.1% betamethasone and 1.5% levofloxacin. After 1 month, the inflammation in the right eye decreased and her BCVA improved to 20/40. However, on day 48 from her initial visit, the inflammation in her right eye worsened and her BCVA decreased to 20/2000 by day 80. Pars plana vitrectomy with silicone oil tamponade was performed to remove the vitreous opacities, and expanded white exudates peripherally and retinal vessels with white sheathing suggestive of acute retinal necrosis (ARN) were seen intraoperatively. Analysis of the vitreous sample revealed EBV positivity on polymerase chain reaction. The patient was diagnosed with EBV-associated ARN and treated with systemic steroids and valaciclovir. The ocular inflammation gradually decreased, and she was discharged from the hospital. However, a week later, the inflammation in the right eye markedly worsened. Despite another course of steroids, the inflammation worsened, resulting in total retinal detachment and absolute glaucoma. Because of the severe pain, the right eye was enucleated.ConclusionsClinicians should be aware that COVID-19 and immunosuppressive treatment can reactivate EBV in the eye.

Acute retinal necrosis in a patient with one seeing eye and reactivated herpesviral infection. A case report

We present a brief description of acute retinal necrosis, a rare and severe condition that is accompanied by a rapid development of inflammatory and occlusive events in the retinal vasculature preceding peripheral necrotizing retinitis. Despite successful etiotropic conservative therapy, the disease is complicated by proliferative vitreoretinopathy with a high risk of retinal detachment, leading to irreversible loss of sight. We present a clinical case of acute retinal necrosis in a patient with one seeing eye who experienced a reactivation of herpes simplex virus type 2 infection, discussing the treatment details and result.

Acute Retinal Necrosis from Reactivation of Varicella Zoster Virus following BNT162b2 mRNA COVID-19 Vaccination

ABSTRACT Purpose To report a case of acute retinal necrosis (ARN) due to varicella zoster virus (VZV) after COVID-19 vaccine administration. Design/methods Observational case report. Result A 62-year-old immunocompetent African American male presented with left eye redness, decreased vision, and floaters after receiving a COVID-19 vaccine seven days prior. Slit-lamp examination revealed diffuse fine endothelial keratic precipitates. Funduscopic examination was notable for vitreous cells, occlusive retinal vasculitis, large retinal hemorrhages, and three quadrants of peripheral areas of retinal whitening. Quantitative polymerase chain reaction testing was positive for varicella zoster virus in the vitreous humor. Treatment with intravitreal and intravenous antiviral therapy resulted in symptomatic improvement. Conclusion COVID-19 mRNA vaccination may cause an immunomodulatory response that leads to reactivation of dormant VZV. Early recognition and treatment can improve visual outcomes.

Acute retinal necrosis caused by co-infection with multiple viruses in a natalizumab-treated patient: a case report and brief review of literature

BackgroundAcute retinal necrosis is considered a rare infectious uveitis. This condition is usually caused by varicella-zoster virus or herpes simplex virus. Acute retinal necrosis caused by co-infection with multiple viruses is extremely rare. Herein, we report a case of acute retinal necrosis caused by co-infection with herpes simplex virus (type I and II) and varicella-zoster virus (VZV) in a natalizumab-treated patient due to multiple sclerosis.Case presentationAn adult man presented with a complaint of decreased vision of the right eye from 12 days ago. He was a known case of multiple sclerosis receiving natalizumab. Examination of the right eye revealed severe conjunctival injection, fine diffuse keratic precipitates, 3 + anterior chamber and vitreous cells, elevated intraocular pressure (26 mmHg), a blurred optic disk with hemorrhagic patches, and occlusive vasculitis plus confluent necrotizing patches in the peripheral retina compatible with diagnosis of acute retinal necrosis. He underwent anterior chamber and vitreous tap, and real-time PCR detected HSV I & II and VZV on the vitreous specimen. A second PCR showed the same result. After neurological consultation, natalizumab was discontinued and intravenous acyclovir was started followed by oral acyclovir and oral prednisolone to control the disease, which was successful.ConclusionsAlthough rare, multiple-viral infection should be considered in the physiopathology of acute retinal necrosis, especially in immunosuppressed patients.

Does ganciclovir exert retinal toxicity after multiple continuous intravitreal injections?

BackgroundThe objective of this study is to report a case of acute retinal necrosis in which abnormalities in visual function did not correspond to retinal anatomical outcomes.Case presentationA 39-year-old female diagnosed with acute retinal necrosis underwent repeated (nine rounds) intravitreal ganciclovir injection (3 mg/0.1 ml) into the left eye, one injection every 2 weeks. During the therapy, the patient noticed her visual acuity declining gradually. The best corrected visual acuity in the left eye was 20/33. The visual field showed massive visual damage. There was no posterior necrotizing involvement, no macular edema or exudation, and only slight abnormity of the interdigitation zone in the fovea area was visible on OCT. Angio-OCT revealed normal capillary density of three retinal capillary and choriocapillaris layers. The visually evoked potential was normal. The photopic single-flash response showed a declined amplitude of a-wave and b-wave. The amplitudes of photopic 30 Hz flicker were decreased. Multifocal electroretinography revealed macular dysfunction.ConclusionGanciclovir-associated photoreceptor damage may induce abnormalities in retinal function in response to multiple continuous intravitreal ganciclovir injections at a relatively high dosage (3 mg/0.1 ml).

Histopathology and Molecular Biology Study of an Eyeball of a Case of Acute Retinal Necrosis

ABSTRACT Purpose To report a histopathology and molecular biology study of an eyeball of a case of acute retinal necrosis (ARN). Methods Histopathology, immunohistochemistry and molecular biology of an enucleated globe of acute retinal necrosis 6 years after the onset of ARN. Results Histopathology showed persistence of chronic inflammatory cells with herpes virus inclusion body. Semi nested polymerase chain reaction showed varicella zoster virus. Conclusions Chronic inflammatory cells and viral genome can be persistent even after 6 years after the onset of ARN.

Simultaneous amplification of herpes simplex virus type 2 and Epstein–Barr virus in an immunocompetent host with acute retinal necrosis

Acute retinal necrosis (ARN) is an ocular inflammatory disease characterized by panuveitis and retinal vasculitis. Herpes virus is strongly associated with ARN and can often be detected by polymerase chain reaction (PCR) of vitreous samples. The authors report a case of ARN associated with herpes simplex virus-2 (HSV-2) and Epstein–Barr virus (EBV) in an immunocompetent host. A 72-year-old man with a history of herpes zoster ophthalmicus presented with sudden vision loss in the left eye in the setting of hypertensive anterior uveitis and severe vitreous inflammation. ARN was diagnosed and antiviral and steroid treatment was initiated. Vitritis improved 1 week later and foci of retinal necrosis with occlusive vasculitis were observed. Three days later, a rhegmatogenous retinal detachment developed. Pars plana vitrectomy with retinopexy was performed and a vitreous PCR test was positive for both HSV-2 and EBV. Despite retinal reattachment, visual acuity did not improve. Prophylactic antiviral therapy was continued for the fellow eye. The coexistence of more than one virus in the ARN context is exceedingly rare and might be associated with poor visual outcomes.

This issue of Acta

This issue of Acta

A Case of Acute Retinal Necrosis in Healthy Childhood

Purpose: To describe a case of acute retinal necrosis (ARN) in childhood. Case summary: A 6-year-old child visited our clinic complaining of conjunctival injection and decreased visual acuity in the left eye. Slit-lamp examination showed conjunctival injection, inflammatory cells (4+) in the anterior chamber, and keratic precipitates. Fundus examination showed disc swelling. The patient was treated with 30 mg of oral prednisolone and 1% prednisolone acetate with the suspicion of uveitis. After 2 days, retinal examination showed a peripheral multifocal yellowish patch and retinal hemorrhage. Herpes simplex virus-2 was detected using polymerase chain reaction (PCR) analysis of the aqueous humor, which was obtained by anterior chamber paracentesis. In the present case, ARN in childhood was successfully treated with intravenous acyclovir. Conclusions: We report a case of ARN in childhood diagnosed using PCR. Intravenous acyclovir may be an effective therapy in children with ARN. Ophthalmologists should promptly perform PCR analysis in patients diagnosed with ARN. J Korean Ophthalmol Soc 2016;57(1):125-129

Use of intravitreal triamcinolone for the treatment of optic nerve edema in a patient with acute retinal necrosis: case report.

To report the use of combined intravitreal triamcinolone and foscarnet therapy in a patient with active acute retinal necrosis. Retrospective case report. A 40-year-old white woman with a history of ulcerative proctitis, intolerant to oral steroids, developed an aggressive case of acute retinal necrosis complicated by severe optic nerve edema resulting in 20/200 vision. Intravitreal foscarnet provided an initial improvement of the vitritis and retinitis; however, optic nerve edema and 20/200 vision persisted. After 2 weeks, intravitreal triamcinolone was combined with the foscarnet dose. Four days later, the optic nerve edema had resolved, the vision returned to 20/40, and the herpetic infection remained controlled. Eight months later, the patient had not experienced a retinal detachment, and acuity was 20/20. Oral steroids are an accepted adjunct to antiviral therapy in acute retinal necrosis; however, combined intravitreal steroid and antiviral therapy has not been previously reported. After combined intravitreal therapy was attempted, the patient experienced a rapid resolution of symptoms without exacerbating her retinitis. In select patients, combined intravitreal triamcinolone and foscarnet may be effective in treating acute retinal necrosis and its inflammatory sequelae.

A case of presumed acute retinal necrosis after intraocular foreign body injury

The aim of this study was to report a case of acute retinal necrosis (ARN) after intraocular foreign body removal. A 32-year-old male presented with visual loss in the left eye. He was hit by an iron fragment while he was hammering. An intraocular foreign body was found with corneal laceration and traumatic cataract. On the day he was injured, primary closure of the laceration, lensectomy, and vitrectomy were performed, and the foreign body was removed. The day after the operation, there was no sign of retinal detachment or retinitis. Two days after the operation, retinal necrosis and accompanying vitreous inflammation were noted in the far periphery. On day 3, the necrosis spread circumferentially and inflammation became more distinct. ARN was presumed and intravenous acyclovir was administered. The necrotic areas were reduced 2 days later, and were resolved in 1 month. The final visual acuity in his left eye was 20/20 after implantation of an intraocular lens. This case is the first report of ARN after penetrating injury and an intraocular foreign body. ARN may develop after open-globe injury.

幼儿急性视网膜坏死之病例报告

目的：报告一个5岁女童罹患急性视网膜坏死之少见病例。方法：病例报告。结果：一名5岁女童因多日前突发性右眼红痛及视力模糊而求诊，病患于1岁时曾有疱疹病毒性脑炎之病史。眼科理学检查发现右眼视力为0.1，左眼为1.0。裂隙灯检查发现右眼前房及玻璃体皆有中度炎症反应，视网膜周边则出现坏死性区域。由于其典型之眼底病灶，故诊断为急性视网膜坏死，并开始给予静脉注射Acyclovir及类固醇眼药水治疗。儿科检查和实验室测试，包括免疫测试，都是正常的。十天后改为口服Valaciclovir并加上口服类固醇治疗。药效初期反应良好，三星期后视网膜坏死区域已减少，患眼视力也进步至0.3；口服类固醇逐步减量，原先之病灶于4星期后皆已消失，仅留下视网膜色素层变化，但于治疗7星期后倂发裂孔性视网膜剥离。结论：我们报告一例急性视网膜坏死发生于5岁女童之少见病例，病患经全身性抗病毒药物合倂口服类固醇治疗后一度恢复良好，但于治疗7星期后倂发裂孔性视网膜剥离。 Purpose: To report an uncommon case of acute retinal necrosis in a 5-year-old girl. Methods: Case report. Results: A 5-year-old girl presented with redness, ocular pain and blurred vision present for few days on the right eye. The past medical history revealed herpetic encephalitis at the age of 1. On examination, visual acuity was 6/60 on the right and 6/6 on the left. Slit-lamp examination showed moderate anterior uveitis and vitritis in her right eye. Fundoscopy showed large areas of peripheral circumferential retinal necrosis. Under the diagnosis of acute retinal necrosis due to its typical fundus lesions, treatment with intravenous Acyclovir and topical steroid eyedrops were started immediately. Pediatric examination and laboratory testing, including immunologic tests, were normal. After 10 days, treatment was changed to oral Valaciclovir and Prednisolone. Topical treatment was tapered gradually. The response was well initially, with resolution of retinitis patches and improvement of visual acuity to 6/20 in 3 weeks. Oral steroids were gradually reduced, and original lesions completely disappeared in 4 weeks, leaving only retinal pigment epithelial change. Seven weeks later, vision dropped to counting finger on the right due to rhegmatogeous retinal detachment. Conclusion: We report an uncommon case of acute retinal necrosis in a 5-year-old girl. This patient responded well to systemic antiviral medication and steroid initially but developed rhegmatogeous retinal detachment 7 weeks later.

Herpes simplex encephalitis presenting after steroid treatment of panuveitis

A 62-year-old woman with an autoimmune disease presented with panuveitis and was treated with immune suppression. She subsequently developed herpetic acute retinal necrosis and later died of herpes simplex encephalitis. Acute retinal necrosis usually occurs months to years after herpes simplex encephalitis. In our case, the ocular findings were present for 5 weeks before the encephalitis presented. To our knowledge, this is the first Australian case of acute retinal necrosis preceding herpes simplex encephalitis.

Intravitreal Foscarnet for the Treatment of Acyclovir-resistant Acute Retinal Necrosis Caused by Varicella Zoster Virus

Purpose: To report of a case of acute retinal necrosis (ARN), successfully treated with intravitreal foscarnet.Methods: Case report.Results: A 40-year-old man diagnosed with varicella zoster virus (VZV)-induced ARN failed standard acyclovir treatment. He was treated subsequently with intravenous foscarnet, but developed acute renal failure after 1 day of treatment. All systemic anti-viral agents were discontinued, and intravitreal foscarnet was administered weekly. After 5 injections, the retinitis was dramatically improved.Conclusions: Intravitreal foscarnet was efficacious in the treatment of acyclovir-resistant ARN caused by VZV. It may be used as the sole treatment in patients with intolerance to systemic administration.

ACUTE RETINAL NECROSIS AFTER INTRAOCULAR TRIAMCINOLONE ACETONIDE INJECTION

The purpose of this study was to report a case of acute retinal necrosis after combined cataract surgery and intracameral triamcinolone acetonide injection in a healthy elderly patient. Testing used was a clinical examination including fundus photographs, fluo-rescein angiography, and serologic testing. A 75-year-old healthy white woman undergoing cataract extraction received an injection of intracameral triamcinolone acetonide as a substitute for postoperative topical steroids. Two weeks later, the patient developed acute retinal necrosis, which responded well to systemic antiviral therapy. Acute retinal necrosis is a rare, but potentially devastating, complication that may be associated with intraocular triamcinolone acetonide injection.

Acute retinal necrosis by cytomegalovirus in an immunocompetent adult: case report and review of the literature

A rare case of acute retinal necrosis caused by cytomegalovirus in an immunocompetent adult, diagnosed by polymerase chain reaction of vitreous aspirate, with good visual outcome after intravitreal and intravenous ganciclovir and oral prednisolone therapy, is reported. A 50-year-old healthy lady presented with redness and diminution of vision in her right eye of 10 days duration. She had anterior chamber inflammation, marked vitritis, and anterior retinal necrosis in the right eye. Blood and other investigations did not reveal any infectious diseases and HIV testing was negative. The retinal lesions and panuveitis resolved with treatment. Two months later she developed retinal detachment which was treated successfully. The best-corrected vision was 6/12 in the right eye. Seven cases of cytomegalovirus ocular infection in immunocompetent healthy adults, reported in the literature, were reviewed. The different presentations of this disease and the importance of suspecting this causative agent are highlighted.

Varicella zoster virus acute retinal necrosis following eye contusion: case report

BackgroundAcute retinal necrosis is a sight-threatening disease caused by the group of herpesviruses. The aim of this paper is to report a case of acute retinal necrosis following ocular trauma in a patient initially treated with vaso-active drugs and corticosteroids for presumed ocular ischemic syndrome.Case presentationA 51-years-old otherwise healthy man, who suffered from sudden visual loss in the left eye following contusion, was commenced on vaso-active drugs and systemic corticosteroids for suspected ocular ischemic syndrome with extensive swelling of the optic disc and macular edema. Subsequently, vision in the initially uninvolved right eye decreased. Polymerase chain reaction of vitreous samples and retinal biopsy confirmed varicella zoster virus. Despite intensive treatment with intravenous antiviral medication, the patient became completely blind in both eyes.ConclusionInitial treatment of acute, unexplained visual decrease with systemic corticosteroids may lead to visual loss in patients with developing acute retinal necrosis. Ocular trauma could have induced and corticosteroid treatment promoted reactivation of a latent viral infection in our patient.

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. (J Jpn Ophthalmol Soc 103:477–481, 1999)