Herpes simplex virus type 2 mediated acute retinal necrosis in a pediatric population: case series and review

  • Ruwan A. Silva
  • Audina M. Berrocal
  • Darius M. Moshfeghi
  • Mark S. Blumenkranz
  • Steven Sanislo
  • Janet L. Davis
Medical Ophthalmology

DOI: 10.1007/s00417-012-2164-8

Cite this article as:
Silva, R.A., Berrocal, A.M., Moshfeghi, D.M. et al. Graefes Arch Clin Exp Ophthalmol (2013) 251: 559. doi:10.1007/s00417-012-2164-8

Abstract

Background

We report 15 eyes with herpes simples virus type 2 (HSV-2) mediated acute retinal necrosis (ARN) in order to better characterize pathogenesis, clinical course, diagnosis, and outcomes of the disease.

Methods

Retrospective observational case series of 14 patients (15 eyes) all aged 21 years or younger with acute retinal necrosis resulting from HSV-2 and examined between 1995 and 2009. Patients were diagnosed by various techniques, including polymerase chain reaction (PCR) of aqueous, vitreous, and serum, antibody determination of serum and intraocular fluids, fundoscopic exam, a therapeutic trial of antivirals active against HSV-2, or a combination thereof.

Results

Mean age of presentation was 11.7 years (range, newborn to 21.0 years) with a standard deviation of 7.0 years. Mean initial vision was 20/200 (median, 20/400; range, 20/20 to LP). Eleven patients (73.3 %) had received oral, injectable, or topical corticosteroids, and 14 (93.3 %) had received antiviral therapy. All patients were diagnosed based on evaluation of intraocular fluids and tissue by antibody determinations, culture, PCR, histopathologic examination, or a combination thereof. Mean final visual acuity was 20/400 (median, CF; range, 20/25 to LP) with worsened visual acuity in five eyes (33.3 %). Anatomically, 14 of 15 eyes had healed or improved retinal appearance.

Conclusions

In a pediatric population with acute retinal necrosis, HSV-2 should be considered as the prime candidate virus. Diagnosis of HSV-2 acute retinal necrosis is accomplished mainly by PCR of ocular specimens. Prompt diagnosis may lead to appropriate anti-viral therapy.

Keywords

Herpes simplex virus type 2 Acute retinal necrosis PCR Antivirals Steroids 

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Ruwan A. Silva
    • 1
    • 2
  • Audina M. Berrocal
    • 2
  • Darius M. Moshfeghi
    • 1
  • Mark S. Blumenkranz
    • 1
  • Steven Sanislo
    • 1
  • Janet L. Davis
    • 2
  1. 1.Department of OphthalmologyStanford University School of MedicineStanfordUSA
  2. 2.Department of Ophthalmology, Bascom Palmer Eye InstituteUniversity of MiamiMiamiUSA