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Fernando A. Esposito, Ghislaine Ducos, Thi Tran, Nathalie Cassoux, Christine Fardeau, Phuc Lehoang, Bahram Bodaghi; Long-term Visual Outcome Of Patients Presenting With Necrotizing Viral Retinopathies. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4268.
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To determine the long-term visual outcome of patients presenting with a Necrotizing Viral Retinopathy (NVR), according to clinical characteristics, virological findings, complications and therapeutic management.
The files of patients referred to our Department between may 1997 and may 2000 for the therapeutic management of a NVR were retrospectively reviewed. Diagnosis of NVR was performed using the PCR- analysis of ocular fluids and response to antiviral therapy. We analyzed findings at initial examination, medical history, clinical evolution under treatment, complications and final visual acuity.
20 patients (24 eyes) were retrospectively reviewed, including 10 men and 10 women with a mean follow-up of eight years (range 5-13 y). Final visual acuity ranged from light perception to 20/20. The most frequent acute complication was necrosis progression requiring aggressive antiviral therapy. We also observed delayed complications challenging visual outcomes with a retinal detachment (9 eyes), a chronic vitritis with macular edema (9 eyes), an optic atrophy (5 eyes), an epimacular membrane (6 eyes), a viral relapse (2 eyes) or a phtysis bulbi (3 eyes). At the last examination, 17 patients had a long-term low dose antiviral ttherapy. Poor visual outcome was associated with an extensive area of retinal necrosis at referral, an HSV-2 or VZV infection and the misuse of systemic corticosteroids.
Several years after being diagnosed with a NVR, patients have to face different types of complications, and undergo regular follow-up with intense medical care, to stabilize visual acuity after healing retinitis. Ocular inflammation may occur during the follow-up without significant viral replication. Long-term antiviral therapy is well tolerated and may prevent any further viral relapse.
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