Uveitis Service, Aravind Eye Hospital & PG Institute of Ophthalmology, Madurai, India.
Ophthalmology. 2013 Sep;120(9):1820-6. doi: 10.1016/j.ophtha.2013.02.006. Epub 2013 May 1.
To describe the ocular features of West Nile virus (WNV) infection proven by serology and molecular diagnostic techniques.
Prospective case series.
Fifty-two patients who presented to the uveitis clinic with ocular inflammatory signs and history of fever preceding ocular symptoms between January 2010 and January 2012 were enrolled for laboratory diagnosis. Serum samples were collected from 30 healthy controls from the same geographic area.
Patients were tested for all endemic infectious diseases that can cause ocular inflammation by serology or molecular diagnostics. When patients had positive antibodies for WNV, serum/plasma samples were tested by real-time reverse transcription (RT) polymerase chain reaction (PCR) and RT loop-mediated isothermal gene amplification assays. The PCR product was subjected to nucleotide sequencing. Fundus fluorescence angiography (FFA), optical coherence tomography (OCT), and indocyanine green angiography were performed. Visual prognosis was analyzed.
Clinical signs (retinitis, neuroretinitis, and choroiditis) and ocular complications (decrease in vision).
A total of 37 of 52 patients (71%) showed positive results for at least 2 laboratory tests for WNV. Fundus examination revealed discrete, superficial, white retinitis; arteritis; phlebitis; and retinal hemorrhages with or without macular star. The FFA revealed areas of retinal inflammation with indistinct borders, vascular and optic disc leakage, vessel wall staining, or capillary nonperfusion. Indocyanine green angiography confirmed choroidal inflammation in 1 of the patients who was diabetic. The OCT scan of the macula revealed inner retinal layer edema in active inflammation and retinal atrophy in late stage. At the final visit, 43% of patients had visual acuity better than 6/12.
In addition to previously reported clinical signs, retinitis, neuroretinitis, and retinal vasculitis were seen in this population. Atrophy of the inner retinal layer was seen on OCT after resolution of inflammation. Visual prognosis was good in patients with focal retinitis and poor in patients with occlusive vasculitis.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
描述通过血清学和分子诊断技术证实的西尼罗河病毒（WNV）感染的眼部特征。
前瞻性病例系列。
2010 年 1 月至 2012 年 1 月，52 名因眼部炎症体征和眼部症状前发热史就诊于葡萄膜炎诊所的患者被纳入实验室诊断。从同一地理区域的 30 名健康对照中采集血清样本。
通过血清学或分子诊断对所有可能引起眼部炎症的地方性传染病进行检测。当患者对 WNV 产生阳性抗体时，通过实时逆转录（RT）聚合酶链反应（PCR）和 RT 环介导等温基因扩增检测对血清/血浆样本进行检测。PCR 产物进行核苷酸测序。进行眼底荧光血管造影（FFA）、光学相干断层扫描（OCT）和吲哚菁绿血管造影。分析视力预后。
临床体征（视网膜炎、神经视网膜炎和脉络膜炎）和眼部并发症（视力下降）。
52 例患者中共有 37 例（71%）至少有 2 项 WNV 实验室检测结果为阳性。眼底检查显示离散、浅表、白色视网膜炎；动脉炎；静脉炎；视网膜出血伴或不伴黄斑星。FFA 显示视网膜炎症边界不清、血管和视盘渗漏、血管壁染色或毛细血管无灌注区。1 例糖尿病患者的吲哚菁绿血管造影证实脉络膜炎症。黄斑 OCT 扫描显示活动期炎症时内视网膜层水肿和晚期视网膜萎缩。末次随访时，43%的患者视力优于 6/12。
除了先前报道的临床体征外，该人群还出现了视网膜炎、神经视网膜炎和视网膜血管炎。炎症消退后，OCT 显示内视网膜层萎缩。局灶性视网膜炎患者的视力预后良好，闭塞性血管炎患者的视力预后较差。
作者没有在本文讨论的任何材料中拥有专有的或商业的利益。
