Limits...
Long-term outcomes in patients undergoing vitrectomy for retinal detachment due to viral retinitis.

Almeida DR, Chin EK, Tarantola RM, Tegins EO, Lopez CA, Boldt HC, Gehrs KM, Sohn EH, Russell SR, Folk JC, Mahajan VB - Clin Ophthalmol (2015)

Bottom Line: Lack of optic nerve involvement correlated with improved final visual acuity of 20/100 or greater.Pars plana vitrectomy (n=12), silicone-oil tamponade (n=11), and scleral buckling (n=10) provided successful anatomic retinal reattachment in all cases, with no recurrent retinal detachment and no cases of hypotony during the follow-up period.Vitrectomy with silicone-oil tamponade and scleral buckle placement provided stable anatomical outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.

ABSTRACT

Purpose: To determine the outcomes in patients with rhegmatogenous retinal detachment (RRD) secondary to viral retinitis.

Patients and methods: This was a retrospective, consecutive, noncomparative, interventional case series of 12 eyes in ten patients with RRD secondary to viral retinitis. Results of vitreous or aqueous biopsy, effect of antiviral therapeutics, time to retinal detachment, course of visual acuity, and anatomic and surgical outcomes were investigated.

Results: There were 1,259 cases of RRD during the study period, with 12 cases of RRD secondary to viral retinitis (prevalence of 0.95%). Follow-up was available for a mean period of 4.4 years. Varicella zoster virus was detected in six eyes, herpes simplex virus in two eyes, and cytomegalovirus in two eyes. Eight patients were treated with oral valacyclovir and two patients with intravenous acyclovir. Lack of optic nerve involvement correlated with improved final visual acuity of 20/100 or greater. Pars plana vitrectomy (n=12), silicone-oil tamponade (n=11), and scleral buckling (n=10) provided successful anatomic retinal reattachment in all cases, with no recurrent retinal detachment and no cases of hypotony during the follow-up period.

Conclusion: Varicella zoster virus was the most frequent cause of viral retinitis, and lack of optic nerve involvement was predictive of a favorable visual acuity prognosis. Vitrectomy with silicone-oil tamponade and scleral buckle placement provided stable anatomical outcomes.

No MeSH data available.


Related in: MedlinePlus

Acute retinal necrosis with macular and optic nerve involvement (case 5).Notes: (A) Preoperative color fundus photography of case 5 illustrates retinal whitening in the macula with peripheral retinal necrosis. There is optic nerve involvement, with disk hyperemia and edema. There is moderate vitritis with a macula-off rhegmatogenous retinal detachment. Presenting visual acuity was 20/800. (B) Postoperative color fundus photography 2 months after cataract extraction with placement of a posterior-chamber intraocular lens and 23-gauge pars plana vitrectomy with silicone-oil tamponade. Final visual acuity was “counts fingers”.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4514312&req=5

f2-opth-9-1307: Acute retinal necrosis with macular and optic nerve involvement (case 5).Notes: (A) Preoperative color fundus photography of case 5 illustrates retinal whitening in the macula with peripheral retinal necrosis. There is optic nerve involvement, with disk hyperemia and edema. There is moderate vitritis with a macula-off rhegmatogenous retinal detachment. Presenting visual acuity was 20/800. (B) Postoperative color fundus photography 2 months after cataract extraction with placement of a posterior-chamber intraocular lens and 23-gauge pars plana vitrectomy with silicone-oil tamponade. Final visual acuity was “counts fingers”.

Mentions: In patients with severe immunosuppression, progressive outer retinal necrosis tends to be bilateral and presents with a predilection for the posterior pole with satellite lesions and lack of vitreous cells.30 Given its early involvement of the macula and posterior pole, progressive outer retinal necrosis usually causes a dramatic drop in visual acuity at presentation, and two-thirds of eyes progress to no light-perception vision within 4 weeks of onset.31 Intravitreal ganciclovir offers a targeted approach, and may result in better visual outcomes for these patients.32 Interestingly, we found five cases (42%) of viral retinitis with macular pathology (cases 2, 5, 6 [OU], and 7 in Figure 1; case 5 in Figure 2), despite the clinical scenario being consistent with ARN. This finding did not correlate with immune status or visual acuity, but illustrates that viral retinitis may present with posterior-pole pathology. To our knowledge, this finding has not been reported in the literature, possibly because it is not included in the ARN diagnostic clinical criteria.


Long-term outcomes in patients undergoing vitrectomy for retinal detachment due to viral retinitis.

Almeida DR, Chin EK, Tarantola RM, Tegins EO, Lopez CA, Boldt HC, Gehrs KM, Sohn EH, Russell SR, Folk JC, Mahajan VB - Clin Ophthalmol (2015)

Acute retinal necrosis with macular and optic nerve involvement (case 5).Notes: (A) Preoperative color fundus photography of case 5 illustrates retinal whitening in the macula with peripheral retinal necrosis. There is optic nerve involvement, with disk hyperemia and edema. There is moderate vitritis with a macula-off rhegmatogenous retinal detachment. Presenting visual acuity was 20/800. (B) Postoperative color fundus photography 2 months after cataract extraction with placement of a posterior-chamber intraocular lens and 23-gauge pars plana vitrectomy with silicone-oil tamponade. Final visual acuity was “counts fingers”.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4514312&req=5

f2-opth-9-1307: Acute retinal necrosis with macular and optic nerve involvement (case 5).Notes: (A) Preoperative color fundus photography of case 5 illustrates retinal whitening in the macula with peripheral retinal necrosis. There is optic nerve involvement, with disk hyperemia and edema. There is moderate vitritis with a macula-off rhegmatogenous retinal detachment. Presenting visual acuity was 20/800. (B) Postoperative color fundus photography 2 months after cataract extraction with placement of a posterior-chamber intraocular lens and 23-gauge pars plana vitrectomy with silicone-oil tamponade. Final visual acuity was “counts fingers”.
Mentions: In patients with severe immunosuppression, progressive outer retinal necrosis tends to be bilateral and presents with a predilection for the posterior pole with satellite lesions and lack of vitreous cells.30 Given its early involvement of the macula and posterior pole, progressive outer retinal necrosis usually causes a dramatic drop in visual acuity at presentation, and two-thirds of eyes progress to no light-perception vision within 4 weeks of onset.31 Intravitreal ganciclovir offers a targeted approach, and may result in better visual outcomes for these patients.32 Interestingly, we found five cases (42%) of viral retinitis with macular pathology (cases 2, 5, 6 [OU], and 7 in Figure 1; case 5 in Figure 2), despite the clinical scenario being consistent with ARN. This finding did not correlate with immune status or visual acuity, but illustrates that viral retinitis may present with posterior-pole pathology. To our knowledge, this finding has not been reported in the literature, possibly because it is not included in the ARN diagnostic clinical criteria.

Bottom Line: Lack of optic nerve involvement correlated with improved final visual acuity of 20/100 or greater.Pars plana vitrectomy (n=12), silicone-oil tamponade (n=11), and scleral buckling (n=10) provided successful anatomic retinal reattachment in all cases, with no recurrent retinal detachment and no cases of hypotony during the follow-up period.Vitrectomy with silicone-oil tamponade and scleral buckle placement provided stable anatomical outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.

ABSTRACT

Purpose: To determine the outcomes in patients with rhegmatogenous retinal detachment (RRD) secondary to viral retinitis.

Patients and methods: This was a retrospective, consecutive, noncomparative, interventional case series of 12 eyes in ten patients with RRD secondary to viral retinitis. Results of vitreous or aqueous biopsy, effect of antiviral therapeutics, time to retinal detachment, course of visual acuity, and anatomic and surgical outcomes were investigated.

Results: There were 1,259 cases of RRD during the study period, with 12 cases of RRD secondary to viral retinitis (prevalence of 0.95%). Follow-up was available for a mean period of 4.4 years. Varicella zoster virus was detected in six eyes, herpes simplex virus in two eyes, and cytomegalovirus in two eyes. Eight patients were treated with oral valacyclovir and two patients with intravenous acyclovir. Lack of optic nerve involvement correlated with improved final visual acuity of 20/100 or greater. Pars plana vitrectomy (n=12), silicone-oil tamponade (n=11), and scleral buckling (n=10) provided successful anatomic retinal reattachment in all cases, with no recurrent retinal detachment and no cases of hypotony during the follow-up period.

Conclusion: Varicella zoster virus was the most frequent cause of viral retinitis, and lack of optic nerve involvement was predictive of a favorable visual acuity prognosis. Vitrectomy with silicone-oil tamponade and scleral buckle placement provided stable anatomical outcomes.

No MeSH data available.


Related in: MedlinePlus