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Long-term follow-up of herpetic non-necrotizing retinopathy with occlusive retinal vasculitis and neovascularization.

Albert K, Masset M, Bonnet S, Willermain F, Caspers L - J Ophthalmic Inflamm Infect (2015)

Bottom Line: Acyclovir was then added and immunosuppressive tapered and eventually stopped resulting in a resolution of vasculitis.Therapeutic and diagnostic vitrectomy was performed, and PCR was found to be positive for varicella zoster virus (VZV) in a vitreous specimen.A good response was obtained on oral antiviral therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Centre Hospitalier Universitaire Saint-Pierre, Rue Haute 322, 1000 Brussels, Belgium ; Centre Hospitalier Universitaire Brugmann, Place Arthur Van Gehuchten 4, 1020 Brussels, Belgium.

ABSTRACT

Background: Herpetic necrotizing retinitis is a well-recognized entity. A few cases of herpetic non-necrotizing retinitis were previously reported.

Findings: We retrospectively report two cases of herpetic non-necrotizing retinopathy with a long follow-up. A 19-year-old woman presented with a bilateral diffuse occlusive retinal vasculitis, peripheral neovascularization, and no signs of retinal necrosis. Long-lasting immunosuppressive treatment failed to control the vasculitis until herpes simplex virus type 1 (HSV1) was demonstrated by polymerase chain reaction (PCR) in the aqueous. Acyclovir was then added and immunosuppressive tapered and eventually stopped resulting in a resolution of vasculitis. Only two relapses occurred during the next 6 years and responded rapidly to oral acyclovir. An 11-year-old boy presented with unilateral scar of stromal keratitis, severe vitritis, and optic disc neovascularization, followed 6 weeks later by peripheral occlusive retinal vasculitis. Therapeutic and diagnostic vitrectomy was performed, and PCR was found to be positive for varicella zoster virus (VZV) in a vitreous specimen. The inflammation responded to oral acyclovir therapy. Recurrence of anterior uveitis with iris depigmentation occurred 4 months after treatment was arrested. After 4 years, he presented again with a recurrence of anterior inflammation and cystoid macular edema (CME). No sign of inflammation was seen for the next 10 years.

Conclusions: These rare cases support the possible role of herpes viruses (HSV or VZV) in occlusive vasculitis without retinal necrosis. PCR was useful to raise the diagnosis and to adapt the treatment. A good response was obtained on oral antiviral therapy.

No MeSH data available.


Related in: MedlinePlus

Patient 1: fluorescein angiography after antiviral treatment. No signs of vasculitis in both eyes after antiviral treatment.
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Fig4: Patient 1: fluorescein angiography after antiviral treatment. No signs of vasculitis in both eyes after antiviral treatment.

Mentions: Acyclovir therapy was initiated at the dosage 5 × 800 mg daily, tapered, and maintained for 7 months, and immunosuppression was tapered and then arrested. A rapid healing of the vasculitis was obtained (Figure 4). Two relapses of retinal vasculitis were reported about 2 and 4 years after the end of oral acyclovir. Both relapses were treated with oral acyclovir alone (800 mg, 5/day) for 3 weeks, with rapid resolution of the vasculitis and no recurrence until the end of the follow-up in November 2004. Final VA was 20/20 in both eyes.Figure 4


Long-term follow-up of herpetic non-necrotizing retinopathy with occlusive retinal vasculitis and neovascularization.

Albert K, Masset M, Bonnet S, Willermain F, Caspers L - J Ophthalmic Inflamm Infect (2015)

Patient 1: fluorescein angiography after antiviral treatment. No signs of vasculitis in both eyes after antiviral treatment.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4385048&req=5

Fig4: Patient 1: fluorescein angiography after antiviral treatment. No signs of vasculitis in both eyes after antiviral treatment.
Mentions: Acyclovir therapy was initiated at the dosage 5 × 800 mg daily, tapered, and maintained for 7 months, and immunosuppression was tapered and then arrested. A rapid healing of the vasculitis was obtained (Figure 4). Two relapses of retinal vasculitis were reported about 2 and 4 years after the end of oral acyclovir. Both relapses were treated with oral acyclovir alone (800 mg, 5/day) for 3 weeks, with rapid resolution of the vasculitis and no recurrence until the end of the follow-up in November 2004. Final VA was 20/20 in both eyes.Figure 4

Bottom Line: Acyclovir was then added and immunosuppressive tapered and eventually stopped resulting in a resolution of vasculitis.Therapeutic and diagnostic vitrectomy was performed, and PCR was found to be positive for varicella zoster virus (VZV) in a vitreous specimen.A good response was obtained on oral antiviral therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Centre Hospitalier Universitaire Saint-Pierre, Rue Haute 322, 1000 Brussels, Belgium ; Centre Hospitalier Universitaire Brugmann, Place Arthur Van Gehuchten 4, 1020 Brussels, Belgium.

ABSTRACT

Background: Herpetic necrotizing retinitis is a well-recognized entity. A few cases of herpetic non-necrotizing retinitis were previously reported.

Findings: We retrospectively report two cases of herpetic non-necrotizing retinopathy with a long follow-up. A 19-year-old woman presented with a bilateral diffuse occlusive retinal vasculitis, peripheral neovascularization, and no signs of retinal necrosis. Long-lasting immunosuppressive treatment failed to control the vasculitis until herpes simplex virus type 1 (HSV1) was demonstrated by polymerase chain reaction (PCR) in the aqueous. Acyclovir was then added and immunosuppressive tapered and eventually stopped resulting in a resolution of vasculitis. Only two relapses occurred during the next 6 years and responded rapidly to oral acyclovir. An 11-year-old boy presented with unilateral scar of stromal keratitis, severe vitritis, and optic disc neovascularization, followed 6 weeks later by peripheral occlusive retinal vasculitis. Therapeutic and diagnostic vitrectomy was performed, and PCR was found to be positive for varicella zoster virus (VZV) in a vitreous specimen. The inflammation responded to oral acyclovir therapy. Recurrence of anterior uveitis with iris depigmentation occurred 4 months after treatment was arrested. After 4 years, he presented again with a recurrence of anterior inflammation and cystoid macular edema (CME). No sign of inflammation was seen for the next 10 years.

Conclusions: These rare cases support the possible role of herpes viruses (HSV or VZV) in occlusive vasculitis without retinal necrosis. PCR was useful to raise the diagnosis and to adapt the treatment. A good response was obtained on oral antiviral therapy.

No MeSH data available.


Related in: MedlinePlus