Abstract
Purpose :
To analyze the clinical outcomes in polymerase chain reaction (PCR) confirmed Herpes Simplex (HSV) and Varicella Zoster (VZV) Acute Retinal Necrosis.
Methods :
This is a retrospective case series of polymerase chain reaction (PCR) confirmed Acute Retinal Necrosis (ARN) at University of Pittsburgh Medical Center from 2007 to 2018. Ocular microbiology laboratory log was searched for all cases of PCR confirmed HSV or VZV anterior chamber paracentesis specimens. Review of patient charts confirmed the diagnosis of ARN. Charts were reviewed for demographic and clinical data including: age, gender, race, presenting and final visual acuity, treatments, complication of retinal detachment, and surgical techniques.
Results :
Twenty-one cases of ARN were identified. Twelve eyes were positive for HSV2, 8 eyes for VZV, and 1 eye with HSV1. The most common treatment protocol for these eyes was ten days of IV Acyclovir, with intravitreal Foscarnet injections every 72 hours for a total of 3 to 4. Systemic steroids was used to treat vitreous inflammation. The patients were then placed on either oral Acyclovir or Valacyclovir for months afterwards. In four cases, Ganciclovir was used as well. Two HSV2 eyes also received IV Cidofovir, while 2 eyes did not receive intravitreal any adjunctive therapy. The mean age of initial presentation was younger for the HSV2 eyes (42.75 years, range 19 to 76) versus VZV eyes (67.13 years, range 36 to 81, p=0.0066). Presenting visual acuity was slightly worse in HSV2 versus VZV but not significantly (20/100 versus 20/60, p=0.29). The final visual acuity was worse in the HSV2 group when compared to the VZV group (20/150 versus 20/50, p=0.0229). As expected, eyes complicated with retinal detachments in both groups worse (20/200 to 20/300) versus those without detachments (20/50 to 20/40). Retinal detachments occurred more frequently in the HSV2 eyes than VZV eyes (75% vs 25%, p = 0.0319). Of the HSV2 group, 4 patients with retinal detachments were NLP. These eyes had a robust inflammatory reaction that continued progress despite the standard treatment.
Conclusions :
ARN secondary to HSV2 had a higher rate of retinal detachment despite similar treatment protocols. This suggests that combination IV acyclovir and adjuvant intravitreal Foscarnet injections are not sufficient therapy for some cases of HSV2, and in spite of the risks of renal toxicity, IV Cidofovir may be a consideration.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.