You Yong Sung, Lee Sung Jin, Lee Sung Ho, Park Chang Hyun, Kwon Oh Woong
NUNE Eye Hospital, Seoul, Korea.
Korean J Ophthalmol. 2007 Mar;21(1):51-4. doi: 10.3341/kjo.2007.21.1.51.
To describe an unusual case of rapidly progressive outer retinal necrosis (PORN) with vitreous hemorrhage in a 41-year-old woman with acquired immunodeficiency syndrome (AIDS), who had retinitis developed from what was probably varicellar-zoster virus combined with cytomegalovirus (CMV) and herpes simplex type 1,2, as proven by the polymerase chain reaction restriction fragment length polymorphism method (PCR-RFLP).
This study is a case report detailing clinical follow-up and an aqueous humor test by PCR-RFLP.
The deep, white retinal lesions coalesced and progressively expanded in a circumferential manner, with sparing of the perivascular retina. However, retinal and vitreous hemorrhages, unusual findings for PORN, could be noted around the optic nerve. Varicellar-zoster virus (VZV), cytomegalovirus (CMV), and herpes simplex types 1,2 (HSV-1,2) were detected in the aqueous humor by PCR.
PORN has been described as a variant of necrotizing herpetic retinopathy, occurring particularly in patients with AIDS. Although the etiologic agent has been reported to be VZV, concurrent or combined etiologic agents can include HSV-1, HSV-2, and CMV in AIDS patients. Therefore, combined antiviral therapy with acyclovir and ganciclovir could be more reasonable as an initial therapy.
描述一名41岁获得性免疫缺陷综合征（AIDS）女性患者发生的伴有玻璃体出血的快速进展性外层视网膜坏死（PORN）的罕见病例。该患者患有视网膜炎，经聚合酶链反应限制性片段长度多态性方法（PCR-RFLP）证实，可能由水痘-带状疱疹病毒合并巨细胞病毒（CMV）以及1型和2型单纯疱疹病毒引起。
本研究为病例报告，详细描述了临床随访情况以及通过PCR-RFLP进行的房水检测。
深层白色视网膜病变融合并呈环形逐渐扩大，血管周围视网膜未受累。然而，在视神经周围可观察到视网膜和玻璃体出血，这在PORN中并不常见。通过PCR在房水中检测到水痘-带状疱疹病毒（VZV）、巨细胞病毒（CMV）以及1型和2型单纯疱疹病毒（HSV-1、HSV-2）。
PORN被描述为坏死性疱疹性视网膜炎的一种变异型，尤其发生在AIDS患者中。尽管据报道病原体为VZV，但在AIDS患者中，并发或合并的病原体可包括HSV-1、HSV-2和CMV。因此，联合使用阿昔洛韦和更昔洛韦进行抗病毒治疗作为初始治疗可能更为合理。
