Observation of varicella zoster virus-induced acute retinal necrosis: viral load detection and visual outcome

Acute retinal necrosis (ARN) is a rare viral endophthalmitis, and human herpesvirus is the principal pathogen. Early diagnosis and treatment are critical to avoid visual impairment by ARN, and pars plana vitrectomy (PPV) is required in advanced cases. In this study, we evaluated the transition of viral load in ocular fluids of ARN eyes with varicella-zoster virus (VZV) after intravenous acyclovir treatment. Fourteen eyes of 13 patients were analyzed retrospectively. All patients received intravenous acyclovir treatment, and eventually, all eyes underwent PPV. A polymerase chain reaction (PCR) test showed a 100% detection rate in all aqueous humor samples collected before the treatment (Pre-AH), as well as aqueous humor (Post-AH) and vitreous fluid samples (VF), collected during PPV conducted after the treatment. Within eight days or less of acyclovir treatment, viral loads both in AH and VF did not decrease significantly. Furthermore, the viral load of Pre-AH had a strong correlation with that of VH. These data suggest that in ARN eyes with VZV infection, the AH sample for the PCR test was reliable to confirm the pathogen. We propose that short-term treatment of intravenous acyclovir may be insufficient for reducing intraocular viral load, and the Pre-AH sample could be a predictor of viral activity in the eyes after acyclovir treatment.

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Detection of cytomegalovirus in an immunocompetent adult presenting with acute retinal necrosis due to varicella-zoster virus: a case report

Clinical Ophthalmology ◽

10.2147/opth.s81020 ◽

2015 ◽

pp. 853

Author(s):

Atsushi Hayashi ◽

Tohru Daikoku ◽

Kimiyasu Shiraki ◽

Tomoko Nakamura

Keyword(s):

Case Report ◽

Varicella Zoster Virus ◽

Acute Retinal Necrosis ◽

Immunocompetent Adult ◽

Varicella Zoster

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Alpha herpes virus type and viral load in intraocular fluids in patients with acute retinal necrosis

BMJ Open Ophthalmology ◽

10.1136/bmjophth-2018-000247 ◽

2019 ◽

Vol 4 (1) ◽

pp. e000247 ◽

Cited By ~ 1

Author(s):

Joanna von Hofsten ◽

Tomas Bergström ◽

Madeleine Zetterberg

Keyword(s):

Herpes Simplex Virus ◽

Viral Load ◽

Herpes Simplex ◽

Virus Type ◽

Herpes Virus ◽

Visual Outcome ◽

High Viral Load ◽

Acute Retinal Necrosis ◽

Herpès Virus ◽

Simplex Virus

ObjectivesTo identify all patients tested positive for herpes viruses in intraocular samples between 2007 and 2016 in South-Western Sweden and evaluate which of these met the criteria of acute retinal necrosis (ARN). To compare viral load in intraocular samples and virus type with clinical outcome.Method and analysisRetrospective case series. Intraocular samples and serum were analysed with quantitative real-time PCR (qPCR) and presence of antibodies (IgG and IgM) were detected by ELISA in serum.ResultsBetween 2007 and 2016, 13 patients met the clinical criteria of ARN and were PCR-positive in aqueous or vitreous for herpes simplex virus 1 (HSV1; n=4), herpes simplex virus 2 (HSV2; n=3) and varicella zoster virus (VZV; n=6). None of the patients tested positive for cytomegalovirus (n=13) or Epstein Barr virus (n=2) met the criteria of ARN. All ARN patients had specific serum IgG and three patients exhibited virus DNA in serum. There was no correlation between high viral load and worse visual outcome. However, higher viral loads were seen in samples taken earlier in the disease process. Median age was higher (p=0.049) in VZV-ARN than for HSV-ARN patients (60.5 and 45.4 years, respectively) with a tendency of worse best corrected visual acuity at presentation (1.62 and 0.79 log MAR, respectively; p=0.079).ConclusionARN is a reactivation of alpha herpes virus and presence of herpes DNA in serum may occur. VZV-ARN are older than HSV-ARN patients. High viral load does not appear to be a predictor of worse visual outcome, but rather indicates earlier sampling.

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