Elsevier

American Journal of Ophthalmology

Volume 208, December 2019, Pages 376-386
American Journal of Ophthalmology

Original Article
Acute Retinal Necrosis: Virological Features Using Quantitative Polymerase Chain Reaction, Therapeutic Management, and Clinical Outcomes

https://doi.org/10.1016/j.ajo.2019.08.007Get rights and content

Purpose

To evaluate outcomes of patients treated with intensive intravitreal therapy and to describe the evolution of quantitative real-time polymerase chain reaction (qPCR) in patients treated for acute retinal necrosis (ARN) syndrome.

Design

Retrospective observational case series.

Methods

This study included 25 eyes of 24 patients with ARN who were treated and followed up in 2 departments of ophthalmology in Lyon, France. Assessed outcomes included qPCR viral load profile during treatment, number of antiviral intravitreal injections (IVT), retinal detachment rate, and best-corrected visual acuity.

Results

Final visual acuity was 20/200 or less in 20% of cases; the rate of retinal detachment was 16%. Viral load kinetics changed in 3 phases: a first plateau period that was not consistent, a logarithmic decrease phase, and a negativation phase. Mean decay of the logarithm of the viral load was estimated at 0.076 per day; mean time of negativation was 56.1 days. Median IVT number was 9 (range, 0-28). Ten patients were treated with injections until the viral load was undetectable. Resistance to acyclovir was observed in a patient with a prolonged initial plateau of the viral load.

Conclusions

Numerous and prolonged IVTs, used as adjunctive therapy, could improve the prognosis of treated patients by decreasing the risk of retinal detachment and improving visual acuity. QPCR enables monitoring of the response to treatment and can provide evidence for resistance to antiviral treatment by enabling the detection of cases with a prolonged initial plateau of viral load.

Section snippets

Methods

This study was a retrospective observational case series of 24 patients with ARN in the Departments of Ophthalmology of the Croix-Rousse and Edouard Herriot Teaching Hospitals (Lyon, France) who were treated and followed up between May 2010 and December 2016. Cases were identified from the virology department database that contained the qPCR results of herpes viruses from samples of the aqueous humor (AH). All patients met the criteria for ARN defined by the American Uveitis Society.23 Written

Results

The initial patient characteristics are reported in Table 1.

Discussion

To the best of our knowledge, the present study is the largest series to describe the evolution of the viral load of ARN using qPCR during treatment. The antiviral treatment regimen used was largely homogeneous and included initial intravenous therapy combined with biweekly IVTs, followed by oral therapy with weekly IVTs. This treatment protocol yielded good outcomes in terms of VA and the RD rate.

Half of the included patients had a history of herpes infection, making it an important and often

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      Although NGS testing was negative for PRV in the vitreous humor of the right eye, the patient’s vision in the right eye gradually and continuously became impaired, owing to retinal detachment and a complicated cataract; meanwhile, retinal detachment recurred in the left eye after vitrectomy. Hafidi et al. found that numerous and prolonged intravitreal antiviral injections, used as adjunctive therapy, could improve the prognosis of ARN patients by decreasing the risk of retinal detachment and improving visual acuity (Hafidi et al., 2019). This discovery provides a new idea for the treatment of our patients in the future.

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