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MA Pisacano, GL Wang, M Harooni; Optic Disk and Retinal Neovascularization Complicating Viral Retinitis . Invest. Ophthalmol. Vis. Sci. 2002;43(13):496.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: 1) To report for the first time Acute Retinal Necrosis complicated by disk and retinal neovascularization in an immunocompromised host 2) To illustrate the variability of presentations of viral retinitides in immunocompromised hosts and the difficulty in distinguishing between them 3) To provide support for previous reports that control of retinitis may depend predominantly on level of immune function Methods: Case presentation. A 47 year old African American woman with AIDS, a CD4 count of 40, presented with progressively decreasing vision, mild photophobia, and floaters over one month. Her exam revealed 20/60 vision OD and 20/25 OS, a right afferent pupillary defect, and 2-3+ anterior chamber cells and vitreitis . Fundoscopy revealed distinct areas of whitening extending approximately four clock hours in the middle and far peripheral fundus nasally in both eyes but more extensive in the right eye. She was treated with intravenous aciclovir, ganciclovir and topical prednisolone acetate 1%. Four weeks later on a follow up exam a neovascular net covering the superonasal third of the disk and a nother neovascular net inferonasally about 1.5 DD from the disk were noted in the right eye. The patient was subsequently photocoagulated multiple times before significant regression of the NVD was achieved. Results: Color Fundus Photographs demonstrating obvious disc neovascularization and retinal neovascularization. Fluorescein angiogram demonstrating moderate to severe retinal nonperfusion of the temporal retina with leakage from the neovascular nets nasally. Conclusion: 1) Neovascularization of the disc, though previously reported in an immune competent patient with ARN may occur in immune compromised individuals as well; however, the extent of vasculitis may be not be commensurate with the severity of the retinal nonperfusion. 2) Distinguishing among viral retinitides (ARN and CMV retinitis and PORN) can be especially difficult in immune-compromised hosts presumably due to the variability in immune-mediated inflammatory response within the vitreous body and retinal vascular walls.
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