Herpes simplex virus type 2 mediated acute retinal necrosis in a pediatric population: case series and review
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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.
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.
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.
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.
KeywordsHerpes simplex virus type 2 Acute retinal necrosis PCR Antivirals Steroids
- 21.Blumenkranz M (1994) Acute retinal necrosis. In: Albert DM, Jakobiec FA (eds) Principles and practice of ophthalmology: Clinical practice. W.B Saunders, PhiladelphiaGoogle Scholar
- 23.Goodpasteur EW, Teague O (1923) Transmission of the virus of herpes fibrilis along nerves in experimentally infected rabbits. J Med Res 44:139–184.7Google Scholar
- 27.Ohashi Y (1999) All for saving the visual axis. In: Streilein JW (ed) Immune response and the eye. Karger, Basel, pp 2–3Google Scholar