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B. Bodaghi, F. Rozenberg, N. Cassoux, C. Fardeau, P. LeHoang; Non-Necrotizing Herpetic Retinopathies Masquerading as Chronic Refractory Posterior Uveitis . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2395.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: Aqueous humor analysis could be proposed in severe atypical forms of posterior uveitis in order to exclude a viral condition and modify the therapeutic management. Methods: Between January 2000 and January 2002, fifty immunocompetent patients presenting with a corticoresistant form of posterior uveitis underwent extensive work-up including anterior chamber paracentesis to rule out a non-necrotizing viral retinopathy. Aqueous samples or cerebrospinal fluid were prospectively obtained. Polymerase chain reaction (PCR) and serologic evaluation of intraocular antibody production were performed by molecular techniques and enzyme-linked immunosorbent assay. PCR and Witmer coefficient for herpes simplex virus types 1 (HSV-1) and 2 (HSV-2), varicella zoster virus (VZV), cytomegalovirus (CMV) and Epstein Barr virus (EBV) were determined on aqueous humor samples. Results: Viral infection was confirmed in 11 cases (22%). Clinical presentation included atypical birdshot retinochoroidopathy, occlusive bilateral vasculitis, cystoid macular edema and pseudo retinitis pigmentosa. Antiviral regimen was initiated in all cases. Inflammation was stabilized, immunosuppressive regimens were discontinued and steroids were significantly tapered in this group of patients. The mean follow-up was 16 months. Conclusions: PCR is a powerful technique that allows detection of minute quantities of DNA in ocular fluids. Identification of a viral agent during severe posterior uveitis can dramatically change the therapeutic management. This preliminary report needs to be completed. Further evaluation is necessary to better characterize this subgroup of atypical chronic posterior uveitis. Certainly, different aspects of the large spectrum of viral retinopathies have still to be defined.
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