Atlas of Ophthalmology

Acute Retinal Necrosis Syndrome in Cytomegalovirus (CMV) Retinitis in Immune-compromised Patient (Colour Photography Posterior Pole; OCT)

Retina -> Infections (see Systemic Diseases)
Patient: 59 years of age, female, BCVA Finger Counting at OD, 0.63 at OS; IOP 10/9 mmHg. General Medical History: kidney transplantion in 2001, taking oral cellsept, steroids immediately prior to presentation at 10.4.2016 with acute post transplant lymphoproliferative disease and deterioration of vision in OD. Ocular Medical History: Cytomegalovirus (CMV) retinitis or acute retinal necrosis (ARN) was suspected at 10.4.2016. Cytomegali virus (CMV) was detected in the anterior chamber, intravenous course of acyclovir was initiated. Purpose: to show effect of systemic therapy with acyclovir over 4 months in Acute Retinal Necrosis Syndrome in Cytomegalovirus (CMV) Retinitis. Methods: Colour Photography Posterior Pole, OCT. Findings: Colour Photography Posterior Pole, initial finding: small Kyrieleis’ plaques within the arteries, retinal infiltration , retinal vasculitis, vitreous opacity, Colour Photography Posterior Pole, after 4 months of therapy with aciclovir: retinal vasculitis with Kyrieleis’ plaques within mainly all arteries, retinal necrosis. OCT, after 4 months of therapy with aciclovir: retinal necrosis, Kyrieleis’ plaques within the arteries. Discussion: Acute Retinal Necrosis Syndrome in CMV retinitis is typical for immuno-compromised patients. Bonfioli et al. (1) summarize d, that acute retinal necrosis (ARN) is an uncommon intraocular inflammatory syndrome characterized by severe and diffuse uveitis, retinal vasculitis, and retinal necrosis. It occurs in immunocompetent patients, and can also be found in immunocompromised subjects. Varicella-zoster virus (VZV), herpes simplex virus (HSV 1 and 2), cytomegalovirus (CMV), and Epstein-Barr virus (EBV) have been implicated in the etiology of ARN. The characteristic features include iridocyclitis, vitritis, retinal necrosis, and retinal vasculitis with Kyrieleis’ vasculitis (2). Kyrieleis’ vasculitis is a condition in which white-yellowish exudates are placed in a beaded pattern within the retinal arteries. The diagnosis of ARN is usually based in clinical features. The use of polymerase chain reaction (PCR) in aqueous humor samples is useful to identify the etiology of the disease. The treatment of ARN includes intravenous acyclovir, corticosteroids and aspirin. To prevent fellow eye involvement, intravenous acyclovir is followed by oral acyclovir for 14 weeks. Alternatives to acyclovir include ganciclovir, foscarnet, famcyclovir, brivudine, and valgancyclovir. Literature: (1) Bonfioli AA, Eller AW. Acute retinal necrosis. Semin Ophthalmol. 2005 Jul-Sep;20(3):155-60. (2) Kyrieleis W. Über atypische Gefässtuberkulose der Netzhaut. Arch Augenheilkd. 1933;107:182–190.

-------------------------- -------------------------- -------------------------- -------------------------- -------------------------- -------------------------- -------------------------- -------------------------- -------------------------- -------------------------- -------------------------- --------------------------

© OnJOph.com