Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK.
Ophthalmology. 2010 Mar;117(3):556-60. doi: 10.1016/j.ophtha.2009.08.003. Epub 2009 Dec 23.
To study the effects of intravitreal foscarnet and the clinical differences between varicella zoster virus (VZV) and herpes simplex virus (HSV) induced acute retinal necrosis (ARN).
Retrospective comparative case series.
Eighty-one eyes of 74 patients.
A retrospective case note analysis was performed in 2 tertiary referral centers.
Presenting and final visual acuity, and progression to retinal detachment.
Thirty-three eyes had HSV-ARN and 48 had VZV-ARN. The average age for HSV-ARN was 34 years and 51 for VZV-ARN (P<0.001). Visual acuity on presentation was similar (P = 0.48), but a larger proportion had better vision (> or =20/60) in the HSV-ARN group (52%) than the VZV-ARN group (35%). A greater proportion of eyes with poor vision (< or =20/200) was found at the 12-month follow-up in the VZV-ARN group (60%) compared with the HSV-ARN group (35%). A greater degree of visual loss in the VZV-ARN group (0.4 logarithm of the minimum angle of resolution [logMAR]) compared with the HSV-ARN group (0.04 logMAR) was detected (P = 0.016). Retinal detachment was 2.5-fold more common in VZV-ARN (62%) compared with HSV-ARN (24%). When comparing eyes treated with (n = 56) and without (n = 25) intravitreal foscarnet, there was a 40% lower rate in retinal detachment (53.6% vs 75.0%) for VZV-ARN (P = 0.23). The numbers with HSV-ARN were too small for analysis.
The results support the difference of outcome in HSV-ARN and VZV-ARN. Therefore, viral identification serves as a key to predicting outcome in these patients. Intravitreal foscarnet seems to be a useful adjunct for the treatment of ARN in that it reduced rate of retinal detachment.
研究玻璃体内膦甲酸治疗水痘带状疱疹病毒（VZV）和单纯疱疹病毒（HSV）引起的急性视网膜坏死（ARN）的效果及两者之间的临床差异。
回顾性对比病例系列研究。
74 例患者的 81 只眼。
在 2 个三级转诊中心进行回顾性病历分析。
发病时和最终视力及视网膜脱离进展情况。
33 只眼为 HSV-ARN，48 只为 VZV-ARN。HSV-ARN 患者的平均年龄为 34 岁，VZV-ARN 为 51 岁（P<0.001）。发病时视力相似（P = 0.48），但 HSV-ARN 组视力较好（>或=20/60）的比例（52%）大于 VZV-ARN 组（35%）。在 12 个月随访时，VZV-ARN 组视力较差（<或=20/200）的比例（60%）大于 HSV-ARN 组（35%）。VZV-ARN 组的视力丧失程度（0.4 最小分辨角对数[logMAR]）大于 HSV-ARN 组（0.04 logMAR）（P = 0.016）。VZV-ARN 中视网膜脱离的发生率（62%）是 HSV-ARN（24%）的 2.5 倍。比较玻璃体内注射膦甲酸治疗（n = 56）和未治疗（n = 25）的眼，VZV-ARN 中视网膜脱离的发生率（53.6%比 75.0%）降低 40%（P = 0.23）。HSV-ARN 例数太少，无法进行分析。
结果支持 HSV-ARN 和 VZV-ARN 之间的预后差异。因此，病毒鉴定是预测此类患者预后的关键。玻璃体内注射膦甲酸似乎是治疗 ARN 的有效辅助手段，可降低视网膜脱离的发生率。
