Purchase this article with an account.
Thomas Jouffroy, Bodaghi Bahram; Etiologic Distribution Of Necrotizing Retinopathies : A Nine-year Experience At A University Referral Centre. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2792.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To assess the etiologic distribution of necrotizing retinopathies based on an extensive work-up including molecular tools applied to ocular fluids.
All patients referred for the diagnostic and therapeutic management of an atypical posterior or panuveitis underwent an extensive work-up to exclude an infectious condition. All patients underwent anterior chamber paracentesis and/or vitrectomy for diagnostic purposes. PCR, Goldmann-Witmer coefficient and cytology were performed in order to confirm an infectious entity or a masquerade syndrome. Treatment was initiated and adapted based on the final diagnosis.
The clinical findings of 218 patients were analyzed in this retrospective study. The sex-ratio (M/F) was 1.45 including 129 men and 89 women. The mean age was 46.6 years (range from 7 To 90 y). An immunocompromised status was identified in 72 cases. A viral infection was confirmed in 146 cases (66.9%). The rate of positivity was 128/146 after ACP and 8/9 after vitrectomy. Viral distribution determined 55 CMV retinitis, 48 VZV retinitis, 34 HSV 1 or 2 retinitis and 9 EBV panuveitis. Nonviral causes of infectious or inflammatory retinopathies were determined in 66 cases, masquerading as a viral retinopathy. Most of the cases were due to a parasitic infection (57.5% Toxoplasma gondii, 1.5% Toxocara cani) followed by primary intraocular lymphoma (12.1%), a bacterial uveitis (7.5%), Behçet’s disease (7.5%), endogenous endophthalmitis (3%), sarcoidosis (1.5%) and others (9.4%). Finally, 6 cases remained idiopathic.
All patients with an atypical retinopathy and a suspicion of infectious etiology deserve an extensive work-up, including ocular fluid analysis. The yield of PCR technology remains excellent for viral retinopathies. Even though most of the cases are viral-induced, other entities may present with similar clinical findings. Therefore, prompt diagnosis remains the best strategy to avoid further sight and rarely life-threatening complications.
This PDF is available to Subscribers Only