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H.J. Kostamaa, R. Narayanan, B. Kuppermann; Optical Coherence Tomography in Progressive Outer Retinal Necrosis . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2571.
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Purpose: To describe the findings of optical coherence tomography (OCT) in a case of progressive outer retinal necrosis (PORN). Design: Observational case report Methods:A 38–year–old HIV positive male presented to the retina service at the University of California, Irvine with a history of cloudy vision in both eyes for 5 days. There were no other significant ocular complaints. The patient had been HIV seropositive for 14 years and had a CD4+ T–lymphocyte count of 16 cells/ mm3 and a viral load of 27,000 copies/mL at the time of presentation. The best–corrected visual acuity in the right eye was 20/200 and 20/150 in the left eye. The intraocular pressures were within the normal range and there were no signs of intraocular inflammation in either eye. Examination of the retina in both eyes revealed a yellowish–white lesion located in the outer retina at the fovea, consistent with the diagnosis of progressive outer retinal necrosis. OCT (StratusTM OCT, Carl Zeiss, Dublin, CA) was performed after dilating the pupils. Results: OCT of the lesions showed an area of extremely low reflectivity with well–defined but irregular borders in the outer retina. The inner retina showed mild hyper–reflectivity while the surrounding retina showed normal reflectivity and was of normal thickness. Conclusions: OCT clearly demonstrates the selective necrosis of the outer retinal layers in PORN. It is a useful adjunct in the early diagnosis of PORN, especially in atypical cases. Even though patients with PORN have an extremely poor prognosis due to rapid progression of the disease and subsequent retinal detachment,2–5 a prompt diagnosis of this disease may help prevent severe visual loss with aggressive therapy. We believe that OCT can be a useful adjunct in the early diagnosis of PORN and in differentiating from lesions such toxoplasma retinochoroiditis.
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