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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 2. Top left: red free photograph of the right eye with residues of the fibrovascular membrane from the optic nerve partially removed during vitrectomy; top right: red free photograph of the unaffected left eye; down: fluorescein angiography of the right eye showing leakage of dye from the optic disc and the posterior and peripheral inflamed retina.
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Fig5: Patient 2. Top left: red free photograph of the right eye with residues of the fibrovascular membrane from the optic nerve partially removed during vitrectomy; top right: red free photograph of the unaffected left eye; down: fluorescein angiography of the right eye showing leakage of dye from the optic disc and the posterior and peripheral inflamed retina.

Mentions: In 1999, an 11-year-old boy presented with a unilateral inferior occlusive retinal vasculitis, optic disc neovascularization, and severe vitritis, limiting the VA of the right eye to 20/50 at presentation. Slight anterior inflammation with scars of endothelial and deep stromal keratitis and inferior pigmented keratic precipitates (KPs) were also observed in the same eye. Six weeks later, he developed inferior retinal neovascularization and VA dropped to 20/200. Because the patient had a tetralogy of Fallot, the surgeon suspected an endogenous bacterial endophthalmitis, and a diagnostic and therapeutic vitrectomy was performed with section of the fibrovascular membranes and photocoagulation of the ischemic non-necrotized peripheral retina. Evaluation of the vitreous specimens revealed the presence of pigmented macrophages without any bacteria. Moreover, PCR performed on the vitreous specimens returned positive for VZV. Oral treatment with acyclovir (5 × 800 mg daily) was administered and VA improved to 20/50. Diffuse leakage of fluorescein was observed from the posterior and peripheral retina as well as the optic disc (Figure 5). Pigmented cells were still present in the anterior vitreous with CME and hypertony during the year following vitrectomy, under topical corticosteroids and oral acyclovir. Oral acyclovir (800 mg, 5/day) was administered for 8 months and then replaced by topical acyclovir and topical steroids for another 8 months. A recurrence of anterior uveitis with posterior iris synechiae and iris depigmentation was observed 4 months later. The patient was lost from follow-up and came back in 2003, after 4 years, with an anterior inflammation with granulomatous inferior KPs of the same eye, slight band keratopathy, depigmentation of the inferior iris, posterior iris synechiae, and posterior subcapsular cataract. The left eye remained normal. The patient was treated with oral acyclovir (800 mg, 5/day) during 3 weeks and long-lasting non-steroidal anti-inflammatory drops. Slight anterior inflammation and CME remained for one more year. No sign of new active inflammation was seen until 2013. The patient had a final VA of 20/200 (right eye) and 20/20 (left eye).Figure 5


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 2. Top left: red free photograph of the right eye with residues of the fibrovascular membrane from the optic nerve partially removed during vitrectomy; top right: red free photograph of the unaffected left eye; down: fluorescein angiography of the right eye showing leakage of dye from the optic disc and the posterior and peripheral inflamed retina.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig5: Patient 2. Top left: red free photograph of the right eye with residues of the fibrovascular membrane from the optic nerve partially removed during vitrectomy; top right: red free photograph of the unaffected left eye; down: fluorescein angiography of the right eye showing leakage of dye from the optic disc and the posterior and peripheral inflamed retina.
Mentions: In 1999, an 11-year-old boy presented with a unilateral inferior occlusive retinal vasculitis, optic disc neovascularization, and severe vitritis, limiting the VA of the right eye to 20/50 at presentation. Slight anterior inflammation with scars of endothelial and deep stromal keratitis and inferior pigmented keratic precipitates (KPs) were also observed in the same eye. Six weeks later, he developed inferior retinal neovascularization and VA dropped to 20/200. Because the patient had a tetralogy of Fallot, the surgeon suspected an endogenous bacterial endophthalmitis, and a diagnostic and therapeutic vitrectomy was performed with section of the fibrovascular membranes and photocoagulation of the ischemic non-necrotized peripheral retina. Evaluation of the vitreous specimens revealed the presence of pigmented macrophages without any bacteria. Moreover, PCR performed on the vitreous specimens returned positive for VZV. Oral treatment with acyclovir (5 × 800 mg daily) was administered and VA improved to 20/50. Diffuse leakage of fluorescein was observed from the posterior and peripheral retina as well as the optic disc (Figure 5). Pigmented cells were still present in the anterior vitreous with CME and hypertony during the year following vitrectomy, under topical corticosteroids and oral acyclovir. Oral acyclovir (800 mg, 5/day) was administered for 8 months and then replaced by topical acyclovir and topical steroids for another 8 months. A recurrence of anterior uveitis with posterior iris synechiae and iris depigmentation was observed 4 months later. The patient was lost from follow-up and came back in 2003, after 4 years, with an anterior inflammation with granulomatous inferior KPs of the same eye, slight band keratopathy, depigmentation of the inferior iris, posterior iris synechiae, and posterior subcapsular cataract. The left eye remained normal. The patient was treated with oral acyclovir (800 mg, 5/day) during 3 weeks and long-lasting non-steroidal anti-inflammatory drops. Slight anterior inflammation and CME remained for one more year. No sign of new active inflammation was seen until 2013. The patient had a final VA of 20/200 (right eye) and 20/20 (left eye).Figure 5

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