Fitoussi Léa, Baptiste Amandine, Mainguy Adam, L'Honneur Anne-Sophie, Bojanova Magdalena, Dechartres Agnès, Rozenberg Flore, Bodaghi Bahram, Touhami Sara
Department of Ophthalmology, Pitié Salpêtrière University Hospital, Sorbonne Université, 75013 Paris, France.
Department of Public Health, Centre de Pharmacoépidémiologie de l'AP-HP (Cephepi), Pitié Salpêtrière University Hospital, Sorbonne Université, 75013 Paris, France.
J Pers Med. 2022 Oct 29;12(11):1785. doi: 10.3390/jpm12111785.
Purpose: Describe the clinical and virological characteristics of viral necrotizing retinitis (VNR) and assess its prognostic factors. Methods: Retrospective study (Pitié Salpêtrière Hospital, Paris) of consecutive VNR patients diagnosed and monitored by qPCR on aqueous humor between 2015 and 2019. All patients received induction therapy with intravenous +/− intravitreal injections (IVI) of antivirals. Results: Forty-one eyes of 37 patients with a mean age of 56 years were included. Involved viruses were VZV (44%), CMV (37%) and HSV2 (19%). Acute retinal necrosis represented 51%, progressive outer retinal necrosis 12% and CMV retinitis 37% of eyes. Forty-six percent of patients were immunocompromised. Median BCVA was 0.7 LogMAR at baseline and 0.8 LogMAR after an average of 14.1 months. VNR bilateralized in 27% of cases after 32 months. Retinal detachment (RD) occurred in 27% of cases after a mean duration of 98 days. Factors associated with a “poor BCVA” at 1 month were: advanced age, low baseline BCVA, high vitritis grade and viral load (VL) at baseline and the “slow responder” status (i.e., VL decrease <50% after 2 weeks of treatment). Factors associated with RD were: advanced age, immunocompetence, low baseline BCVA, high vitritis grade at baseline and use of ≤5 IVIs. Conclusions: Clinical factors including advanced age, immunocompetence, low BCVA and high vitritis grade at baseline were associated with a poor prognosis. New virological factors were predictive of a poor outcome: high baseline VL and the “slow responder” status. Sequential intraocular fluid sampling might help prognosticate the outcomes of VNR.
描述病毒性坏死性视网膜炎（VNR）的临床和病毒学特征，并评估其预后因素。方法：对2015年至2019年间在巴黎皮提耶尔-萨尔佩特里埃医院通过房水定量聚合酶链反应（qPCR）诊断和监测的连续性VNR患者进行回顾性研究。所有患者均接受了静脉内+/-玻璃体内注射（IVI）抗病毒药物的诱导治疗。结果：纳入37例患者的41只眼，平均年龄56岁。涉及的病毒为水痘带状疱疹病毒（VZV，44%）、巨细胞病毒（CMV，37%）和单纯疱疹病毒2型（HSV2，19%）。急性视网膜坏死占51%的眼，进行性外层视网膜坏死占12%，CMV视网膜炎占37%。46%的患者免疫功能低下。基线时最佳矫正视力（BCVA）中位数为0.7 LogMAR，平均14.1个月后为0.8 LogMAR。32个月后，27%的病例VNR变为双侧性。平均98天后，27%的病例发生视网膜脱离（RD）。1个月时与“BCVA差”相关的因素包括：高龄、基线BCVA低、玻璃体炎分级高、基线时病毒载量（VL）高以及“反应缓慢者”状态（即治疗2周后VL下降<50%）。与RD相关的因素包括：高龄、免疫功能正常、基线BCVA低、基线时玻璃体炎分级高以及IVI使用次数≤5次。结论：包括高龄、免疫功能正常、基线BCVA低和基线时玻璃体炎分级高在内的临床因素与预后不良相关。新的病毒学因素可预测不良结局：基线VL高和“反应缓慢者”状态。连续眼内液采样可能有助于预测VNR的结局。
