Lau Chun H, Missotten Tom, Salzmann Joel, Lightman Susan L
Department of Clinical Ophthalmology, Institute of Ophthalmology and Moorfields Eye Hospital, London, United Kingdom.
Ophthalmology. 2007 Apr;114(4):756-62. doi: 10.1016/j.ophtha.2006.08.037. Epub 2006 Dec 20.
To determine the viral diagnosis and factors affecting the visual outcome of eyes with acute retinal necrosis.
Nonrandomized, retrospective, interventional, noncomparative series.
A cohort of 22 human immunodeficiency virus-negative patients with acute retinal necrosis (ARN). There were 17 unilateral and 5 bilateral cases.
Diagnostic vitreous biopsy for polymerase chain reaction (PCR) viral DNA analysis, prophylactic barrier laser posterior to necrotic retina to try to prevent rhegmatogenous retinal detachment (RD), intravenous acyclovir in combination with oral, and vitrectomy for RD repair.
Results of PCR viral DNA analysis, relationship between prophylactic barrier argon laser photocoagulation and occurrence of RD, and visual acuities at presentation and follow-up.
Varicella-zoster virus (VZV) was detected in 66.7% (12/18) of eyes (66.7% of patients [10/15]) with vitreous biopsy and herpes simplex virus (HSV) in 22.2% (4/18) of eyes (20% of patients [3/15]). Epstein-Barr virus (EBV) was detected in 16.7% (3/18) of eyes (20% of patients [3/15]), and all the EBV-positive eyes were also positive for VZV. Polymerase chain reaction results were identical in both eyes of bilateral cases (5 patients) and were negative in 11.1% (2/18) of eyes (13.3% of patients [2/15]) biopsied. Systemic corticosteroid treatment given before ARN diagnosis did not appear to increase the risk of developing RD (P = 0.69). Rhegmatogenous RD occurred in 35.3% (6/17) of eyes given prophylactic argon laser treatment and in 80% (8/10) of eyes that could not be lasered prohylactically. Of RDs, 96.3% (13/14) occurred after the third week and up to 5 months from onset of symptoms. The VA after surgical repair of RD improved relative to the presentation acuity in 33.3% (4/12) of eyes.
Varicella-zoster virus is the leading cause of ARN. We recommend the management of ARN to include prompt diagnosis; prophylactic argon laser retinopexy, preferably within the first 2 weeks to reduce risk of RD; systemic acyclovir; and corticosteroids to control the severe inflammation associated with ARN. Despite the guarded visual prognosis, RD repair may result in improved visual outcomes.
确定急性视网膜坏死患者眼部的病毒诊断及影响视力预后的因素。
非随机、回顾性、干预性、非对照系列研究。
22例人类免疫缺陷病毒阴性的急性视网膜坏死（ARN）患者。其中17例为单眼发病，5例为双眼发病。
进行诊断性玻璃体活检以进行聚合酶链反应（PCR）病毒DNA分析；在坏死视网膜后方进行预防性视网膜光凝术以预防孔源性视网膜脱离（RD）；静脉注射阿昔洛韦联合口服给药；对发生视网膜脱离的患者行玻璃体切除术。
PCR病毒DNA分析结果；预防性氩激光光凝与视网膜脱离发生之间的关系；就诊时及随访时的视力。
玻璃体活检显示，66.7%（12/18）的患眼（66.7%的患者[10/15]）检测到水痘带状疱疹病毒（VZV），22.2%（4/18）的患眼（20%的患者[3/15]）检测到单纯疱疹病毒（HSV）。16.7%（3/18）的患眼（20%的患者[3/15]）检测到EB病毒（EBV），所有EBV阳性的患眼VZV检测也呈阳性。双侧病例（5例患者）双眼的PCR结果相同，11.1%（2/18）的患眼（13.3%的患者[2/15]）活检结果为阴性。在ARN诊断前给予全身糖皮质激素治疗似乎并未增加发生视网膜脱离的风险（P = 0.69）。接受预防性氩激光治疗的患眼中，35.3%（6/17）发生了孔源性视网膜脱离，而未进行预防性激光治疗的患眼中，80%（8/10）发生了视网膜脱离。在发生视网膜脱离的病例中，96.3%（13/14）在症状出现后第三周及之后直至5个月内发生。视网膜脱离手术修复后，33.3%（4/12）的患眼视力相对于就诊时有所改善。
水痘带状疱疹病毒是急性视网膜坏死的主要病因。我们建议急性视网膜坏死的治疗应包括及时诊断；预防性氩激光视网膜固定术，最好在发病后2周内进行以降低视网膜脱离风险；全身应用阿昔洛韦；以及使用糖皮质激素控制与急性视网膜坏死相关的严重炎症。尽管视力预后不佳，但视网膜脱离修复术可能会改善视力结局。
