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Anne Sikorav, Phuc Le Hoang, Flore Rozenberg, Bahram Bodaghi; Monitoring necrotizing viral retinitis by gene amplification of ocular fluids. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2917.
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To analyze the kinetics of viral load in the aqueous humor during necrotizing herpetic retinopathies and to correlate the results with clinical evolution, complications and treatment agressivity.
Monocentric retrospective study of patients with necrotizing herpetic retinitis diagnosed by quantitative or qualitative polymerase chain reaction (PCR) for herpes viruses applied to aqueous humor samples between December 2007 and October 2011. All patients were treated with a combination of intravenous antivirals (aciclovir, ganciclovir or foscarnet) and intravitreal injections (ganciclovir or foscarnet) followed by oral valaciclovir. During evolution, iterative anterior chamber (AC) taps were performed to adapt the therapeutic management.
The study included 19 eyes of 17 patients, with a M/F ratio of 13/4. The average age was 49 years (25-78 years). Herpes simplex virus 1 (HSV-1) was identified in 1 case, herpes simplex virus 2 (HSV-2) in 2 cases, varicella zoster virus (VZV) in 8 cases and cytomegalovirus (CMV) in 6 cases. Acute retinal necrosis syndrome was diagnosed in the majority of cases. An average of 5 AC taps (3-9 taps) was performed in this series. The mean duration of intravenous treatment was 20 days for VZV, 14 d for CMV, 13 d for HSV-2, and 21 d for HSV1. Combined IV antiviral treatment was not more effective on viral load decrease than IV monotherapy. HSV-2 group was followed by qualitative PCR. Immunosuppression was associated with a persistent high viral load. The decrease in viral load was relatively well correlated with the clinical response regardless of the causative virus. No modeling of viral kinetics could be made for HSV2 virus, nor in case of unfavorable evolution with viral load stagnation. In case of viral decrease and regardless of the clinical course, we have modeled the viral kinetics by exponential curves with a coefficient of determination R2 of 0.9. Complications and severity are depending on the virus type.
Severity and evolution of necrotizing herpetic retinitis vary depending on the type of virus involved, possible immunocompromised status and antiviral treatment. Monitoring the viral load kinetics by AC taps optimizes antiviral therapy, thus potentially improving the final visual outcome.
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