Sato Tomohito, Yamamoto Wataru, Tanaka Atsushi, Shimazaki Haruna, Sugita Sunao, Kaburaki Toshikatsu, Takeuchi Masaru
Department of Ophthalmology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan.
Laboratory for Retinal Regeneration, RIKEN Center for Biosystems Dynamics Research, Kobe, Hyogo 650-0047, Japan.
J Clin Med. 2020 Apr 22;9(4):1204. doi: 10.3390/jcm9041204.
Acute retinal necrosis (ARN) is a rare viral endophthalmitis, and human herpesvirus is the principal pathogen. Early diagnosis and treatment are critical to avoid visual impairment by ARN, and pars plana vitrectomy (PPV) is required in advanced cases. In this study, we evaluated the transition of viral load in ocular fluids of ARN eyes with varicella-zoster virus (VZV) after intravenous acyclovir treatment. Fourteen eyes of 13 patients were analyzed retrospectively. All patients received intravenous acyclovir treatment, and eventually, all eyes underwent PPV. A polymerase chain reaction (PCR) test showed a 100% detection rate in all aqueous humor samples collected before the treatment (Pre-AH), as well as aqueous humor (Post-AH) and vitreous fluid samples (VF), collected during PPV conducted after the treatment. Within eight days or less of acyclovir treatment, viral loads both in AH and VF did not decrease significantly. Furthermore, the viral load of Pre-AH had a strong correlation with that of VH. These data suggest that in ARN eyes with VZV infection, the AH sample for the PCR test was reliable to confirm the pathogen. We propose that short-term treatment of intravenous acyclovir may be insufficient for reducing intraocular viral load, and the Pre-AH sample could be a predictor of viral activity in the eyes after acyclovir treatment.
急性视网膜坏死（ARN）是一种罕见的病毒性眼内炎，人疱疹病毒是主要病原体。早期诊断和治疗对于避免ARN导致视力损害至关重要，晚期病例需要进行玻璃体切割术（PPV）。在本研究中，我们评估了静脉注射阿昔洛韦治疗后水痘带状疱疹病毒（VZV）感染的ARN眼眼内液中病毒载量的变化。回顾性分析了13例患者的14只眼。所有患者均接受静脉注射阿昔洛韦治疗，最终所有患眼均接受了PPV。聚合酶链反应（PCR）检测显示，治疗前采集的所有房水样本（Pre-AH）以及治疗后PPV期间采集的房水样本（Post-AH）和玻璃体样本（VF）的检测率均为100%。在阿昔洛韦治疗8天以内，AH和VF中的病毒载量均未显著下降。此外，Pre-AH的病毒载量与VH的病毒载量密切相关。这些数据表明，在VZV感染的ARN眼中，用于PCR检测的AH样本对于确认病原体是可靠的。我们认为，静脉注射阿昔洛韦的短期治疗可能不足以降低眼内病毒载量，Pre-AH样本可能是阿昔洛韦治疗后眼内病毒活性的一个预测指标。
