Treatment Of Herpers Viral Retinopathies In Babies With Severe Immune Deficiency

Abstract

Purpose: : Although retinal and cerebral viral infection by CMV and VZV are common in AIDS patients, they are quite infrequent in patients with other causes of immune deficits. We present a small series of 5 patients with congenital severe congenital immune deficit treated with a bone marrow graft and who presented a CMV or VZV retinitis. We also present the treatment they benefited.

Methods: : Retrospective study of 8 eyes of 5 patients treated between November 1^st 2010 and November 15^th 2011. All presented a congenital immune deficit treated by bone marrow graft and were diagnosed with a viral retinitis. The fundus examination was organised when a leukocoria was discovered or when a viral encephalitis was discovered. As soon as the diagnosed was made, an exam under general anesthesia was performed with an anterior chamber puncture and a intra vitreous injection of either Gancyclovir or Foscarnet. Patients were controlled each week and the injection repeated until the viral replication declined

Results: : No adverse effects were observed following the procedure. All the retinitis regressed. In 7 eyes, a fibrous scar taking the macula was observed. The 8^th eye was diagnosed with an early lesion which regressed with no scar. Two patients presented a bilateral retinal detachment within the month following the last injection.

Conclusions: : The prognostic of CMV or VZV retinopathies is poor. A quick and intensive treatment may lessen retinal damages. Intra vitreous injection allow to reach an effective dose quickly and safely.

Keywords: cytomegalovirus • varicella zoster virus • retinitis