Yang C M, Wang W W, Lin C P
Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.
J Formos Med Assoc. 1999 Feb;98(2):141-4.
Progressive outer retinal necrosis syndrome is a recently recognized variant of necrotizing herpetic retinopathy, developing in patients with acquired immune deficiency syndrome (AIDS) or other conditions causing immune compromise. We report a case in which the diagnosis of retinal necrosis syndrome was made before the diagnosis of AIDS was confirmed. A 41-year-old man presented with a 1-month history of blurred vision in his left eye. Ophthalmologic examination revealed extensive retinal necrosis with total retinal detachment in his left eye and multifocal deep retinal lesions scattered in the posterior fundus as well as in the peripheral retina in his right eye. The serologic test for human immunodeficiency virus (HIV) was positive. Despite intravenous acyclovir treatment for 1 week, the lesions in the right eye showed rapid progression. High doses of intravitreal ganciclovir were then given in addition to intravenous acyclovir. After combined treatment for 1 month, the lesions became quiescent and the visual acuity improved to 20/30. Although the patient soon developed full-blown AIDS, the vision in his right eye remained undisturbed. Physicians should suspect progressive outer retinal necrosis syndrome in any patient with rapidly progressive necrotizing retinopathy and test the patient for HIV infection. Aggressive combined antiviral agent therapy should be considered to save vision.
进行性外层视网膜坏死综合征是坏死性疱疹性视网膜病变的一种最近才被认识的变异型，发生于获得性免疫缺陷综合征（AIDS）患者或其他导致免疫功能受损的疾病患者。我们报告一例在确诊AIDS之前就已诊断出视网膜坏死综合征的病例。一名41岁男性，左眼视力模糊1个月。眼科检查发现左眼广泛视网膜坏死并伴有视网膜全脱离，右眼后极部和周边视网膜散在多发深层视网膜病变。人类免疫缺陷病毒（HIV）血清学检测呈阳性。尽管静脉注射阿昔洛韦治疗1周，但右眼病变仍迅速进展。随后除静脉注射阿昔洛韦外，还给予了高剂量玻璃体内注射更昔洛韦。联合治疗1个月后，病变静止，视力提高到20/30。尽管患者很快发展为典型的AIDS，但右眼视力仍未受影响。对于任何患有快速进展性坏死性视网膜病变的患者，医生都应怀疑进行性外层视网膜坏死综合征，并对患者进行HIV感染检测。应考虑积极联合抗病毒药物治疗以挽救视力。
