Menerath J M, Gerard M, Laurichesse H, Goldschmidt P, Peigue-Lafeuille H, Rozenberg F, Beytout J
Service d'Ophtalmologie, Hôpital Gabriel Montpied, CHU, BP 69, Clermont-Ferrand.
J Fr Ophtalmol. 1995;18(10):625-33.
A case of bilateral progressive outer retinal necrosis occurred after herpes zoster ophthalmicus in a patient with acquired immunodeficiency syndrome. This case does not correspond to the classical picture of progressive outer retinal necrosis. The disease led to blindness despite intravenous therapy with acyclovir and foscarnet. PCR could not identify any virus in the aqueous humour, but VZV is evidenced in cerebrospinal fluid. Acute retinal necrosis is now clearly defined by the American Uveitis Society, which should allow to determine its incidence and risk factors. Herpes zoster usually precedes the acute outer retinal necrosis. The infectious theory (VZV, HSV, CMV) widely prevails over the immune theory. We prefer the virus genome identification in the aqueous humor or in the vitreous by PCR to confirm diagnosis rather than the specific antibody titration. Therapy consists in acyclovir, foscarnet and ganciclovir. But whatever the treatment, the visual prognosis is poor.
一名获得性免疫缺陷综合征患者在发生眼部带状疱疹后出现双侧进行性外层视网膜坏死。该病例与进行性外层视网膜坏死的典型表现不符。尽管使用阿昔洛韦和膦甲酸钠进行了静脉治疗，该疾病仍导致失明。聚合酶链反应（PCR）未能在房水中检测到任何病毒，但在脑脊液中证实了水痘-带状疱疹病毒（VZV）的存在。美国葡萄膜炎学会现已明确界定了急性视网膜坏死，这将有助于确定其发病率和危险因素。带状疱疹通常先于急性外层视网膜坏死出现。感染理论（VZV、单纯疱疹病毒、巨细胞病毒）比免疫理论更为普遍。我们更倾向于通过PCR在房水或玻璃体中鉴定病毒基因组以确诊，而非进行特异性抗体滴定。治疗包括使用阿昔洛韦、膦甲酸钠和更昔洛韦。但无论采用何种治疗方法，视力预后都很差。
