ACUTE RETINAL NECROSIS: Difference in Outcome by Viral Type and Options for Antiviral Therapy.

PURPOSE: To investigate differences in outcomes of acute retinal necrosis with confirmed viral polymerase chain reaction between viral types and highlight different treatment options. METHODS: The study evaluated 22 eyes in 18 patients of polymerase chain reaction-positive acute retinal necrosis at the University of Pittsburgh Medical Center from 2007 to 2018. Outcome measures included final visual acuity, treatment paradigms, and retinal detachment rate. RESULTS: Eight eyes were polymerase chain reaction-positive for varicella zoster virus, two eyes for herpes simplex virus Type 1 (HSV-1), and 12 eyes for herpes simplex virus Type 2 (HSV-2). Final Snellen best-corrected visual acuity averaged 20/51 for varicella zoster virus, 20/25 for HSV-1, and 20/814 for HSV-2. Retinal detachment occurred in 2 (25%) of varicella zoster virus eyes and 8 (75%) of HSV-2 eyes. One eye with HSV-1 and three eyes with HSV-2 received cidofovir for treatment of refractory retinitis. CONCLUSION: Acute retinal necrosis secondary to HSV-2 tended to have persistent active retinitis with a higher rate of retinal detachment despite similar treatment protocols, suggesting that in some cases combination intravenous acyclovir and adjuvant intravitreal foscarnet injections are not sufficient. Despite the risk of renal toxicity, intravenous cidofovir may be a consideration in select patients.

African traditional medication and keloid formation in herpes zoster ophthalmicus.

Keloid scar complicating herpes zoster ophthalmicus (HZO) has not been much reported among Africans despite the African population having dark skin. We report on a middle-aged Nigerian with HZO who developed keloid scar following use of traditional herbs to the herpetic rashes. A 52-year-old immune-competent Nigerian male presented with a 2-week history of vesicular rashes involving the left side of the forehead down to the tip of the nose. He initially presented to an African traditional healer who had advised application of various herbs to the lesion. When he presented to the eye clinic, he was treated for the associated uveitis with significant improvement. The cicatricial skin change gradually became raised with clinical appearance of keloid at 1 year of follow-up. Cicatricial skin changes in HZO are not unusual, but keloid formation among Africans has not been much described. Late presentation, use of traditional herbs some of which have corrosive effect and secondary bacterial infection are the possible factors that may encourage such abnormal wound healing. The myth associated with HZO in the local African setting as well as the fact that African traditional healers are still widely accepted among most African communities may play a role in increasing the risk of keloid formation among our population following HZO infection.

Enfoque multidisciplinario en el tratamiento del herpes zóster oftálmico / Multidisciplinary approach in the treatment of pphthalmic herpes zoster

Se presentó el caso remitido a nuestro servicio de rehabilitación de la especialidad de oftalmología, con el diagnóstico de herpes zóster oftálmico, por presentar dolor y lesiones maculares, vesículas sobre una base eritematosa en la región periorbitaria y frontal derecha, acompañado de intenso edema. Tratado, además, en primera instancia, por dermatología con: aciclovir, antiinflamatorios (prednisona), vitaminoterapia y colirios. A los 7 días comenzó tratamiento de fisioterapia con radiación láser durante 15 sesiones, y continuó con 20 aplicaciones del campo magnético continuo, lo cual garantizó, con la interrelación de varias especialidades médicas y un enfoque multidisciplinario, la evolución satisfactoria del paciente(AU)

Present case was referred to our rehabilitation service of Ophthalmology specialty diagnosed with ophthalmic herpes zoster, pain and macular lesions, vesicles on an erythematous basis in right frontal periorbital region, accompanied of intense edema. The first treatment was applied in the Dermatology service with acyclovir, anti-inflammatory drugs (Prednisone), vitamin-therapy and eyedrops. At 17 days was treated with physiotherapy with laser radiation for 15 sessions continuing 20 applications of continuous magnetic field guarantying with the interrelation of some medical specialties and a multidisciplinary approach, the satisfactory evolution of patient(AU)

Enfoque multidisciplinario en el tratamiento del herpes zóster oftálmico / Multidisciplinary approach in the treatment of pphthalmic herpes zoster

Se presentó el caso remitido a nuestro servicio de rehabilitación de la especialidad de oftalmología, con el diagnóstico de herpes zóster oftálmico, por presentar dolor y lesiones maculares, vesículas sobre una base eritematosa en la región periorbitaria y frontal derecha, acompañado de intenso edema. Tratado, además, en primera instancia, por dermatología con: aciclovir, antiinflamatorios (prednisona), vitaminoterapia y colirios. A los 7 días comenzó tratamiento de fisioterapia con radiación láser durante 15 sesiones, y continuó con 20 aplicaciones del campo magnético continuo, lo cual garantizó, con la interrelación de varias especialidades médicas y un enfoque multidisciplinario, la evolución satisfactoria del paciente

Present case was referred to our rehabilitation service of Ophthalmology specialty diagnosed with ophthalmic herpes zoster, pain and macular lesions, vesicles on an erythematous basis in right frontal periorbital region, accompanied of intense edema. The first treatment was applied in the Dermatology service with acyclovir, anti-inflammatory drugs (Prednisone), vitamin-therapy and eyedrops. At 17 days was treated with physiotherapy with laser radiation for 15 sessions continuing 20 applications of continuous magnetic field guarantying with the interrelation of some medical specialties and a multidisciplinary approach, the satisfactory evolution of patient

Misdiagnosis of burns: herpes zoster ophthalmicus.

Many conditions can mimic the presentation of burns. We present an interesting case in which the initial diagnosis of a chemical burn was later confirmed to be herpes zoster ophthalmicus.

A case of atypical progressive outer retinal necrosis after highly active antiretroviral therapy.

This is a report of an atypical case of progressive outer retinal necrosis (PORN) and the effect of highly active antiretroviral therapy (HAART) on the clinical course of viral retinitis in an acquired immunodeficiency syndrome (AIDS) patient. A 22-year-old male patient infected with human immunodeficiency virus (HIV) presented with unilaterally reduced visual acuity and a dense cataract. After cataract extraction, retinal lesions involving the peripheral and macular areas were found with perivascular sparing and the mud-cracked, characteristic appearance of PORN. He was diagnosed as having PORN based on clinical features and was given combined antiviral treatment. With concurrent HAART, the retinal lesions regressed, with the regression being accelerated by further treatment with intravenous acyclovir and ganciclovir. This case suggests that HAART may change the clinical course of PORN in AIDS patients by improving host immunity. PORN should be included in the differential diagnosis of acute unilateral cataract in AIDS patients.

A Case of Atypical Progressive Outer Retinal Necrosis after Highly Active Antiretroviral Therapy

This is a report of an atypical case of progressive outer retinal necrosis (PORN) and the effect of highly active antiretroviral therapy (HAART) on the clinical course of viral retinitis in an acquired immunodeficiency syndrome (AIDS) patient. A 22-year-old male patient infected with human immunodeficiency virus (HIV) presented with unilaterally reduced visual acuity and a dense cataract. After cataract extraction, retinal lesions involving the peripheral and macular areas were found with perivascular sparing and the mud-cracked, characteristic appearance of PORN. He was diagnosed as having PORN based on clinical features and was given combined antiviral treatment. With concurrent HAART, the retinal lesions regressed, with the regression being accelerated by further treatment with intravenous acyclovir and ganciclovir. This case suggests that HAART may change the clinical course of PORN in AIDS patients by improving host immunity. PORN should be included in the differential diagnosis of acute unilateral cataract in AIDS patients.

Successful treatment of varicella zoster virus retinitis with aggressive intravitreal and systemic antiviral therapy.

AIMS: To describe the successful treatment of varicella zoster virus retinitis (VZVR) using intravenous cidofovir as part of an aggressive management strategy. CASE REPORTS: Two patients with bilateral VZVR were treated with a combination of intravenous cidofovir and ganciclovir with adjuvant intravitreal foscarnet or ganciclovir. Both patients maintained good vision in the less severely affected eye. Retinal detachment did not occur in either patient. CONCLUSIONS: VZVR should be treated aggressively with a combination of intravenous and intravitreal therapy to improve visual prognosis. Intravenous cidofovir, in the absence of contra-indications, should be considered as part of this aggressive therapeutic approach, especially in patients with AIDS in whom the prognosis is particularly poor.

The use of capsaicin in herpes zoster ophthalmicus neuralgia.

The treatment of neuralgia which occurs during and following herpes zoster ophthalmicus is often unsatisfactory. Capsaicin (trans-8-methyl-N-vanillyl-6-nonenamide) is a drug which depletes substance P and may be effective in inhibiting pain. We utilized topical capsaicin to the affected dermatome five times daily for 4 weeks in 6 patients with acute and post herpetic neuralgia. In four cases pain was markedly relieved and narcotic medications were either discontinued or significantly reduced. In two cases, pain was not reduced. Four patients had side effects including burning sensation at the site of the drug administration (4 cases), dermatitis as a result of overuse of the drug (2 cases) and hyperesthesia (1 case). Our results suggest that capsaicin may be a useful therapy for the alleviation of pain in some individuals with herpes zoster ophthalmicus. However, controlled studies are needed to establish these results.

Presumed ophthalmic herpes zoster after contralateral cataract extraction.

Herpes zoster ophthalmicus (HZO) may occur spontaneously, but can be precipitated by stress, trauma, debility or systemic illness. A case is here reported of Herpes zoster involving the contralateral eye, associated with a midline skin rash, following cataract extraction under local anaesthesia.

[Beneficial effects of immunostimulant and antiviral therapy of ophthalmic herpes zoster]. / Les effets bénéfiques de la thérapie immunostimulante et antivirale sur le zona ophtalmique.

A group of 16 patients with ophthalmic zona zoster received antiviral and immunostimulative treatment with Romanian specific products. Results were spectacular. The problem of the identity of the varicella and zoster viruses is discussed.

[The beneficial effects of immunostimulating and antiviral therapy on ophthalmic zona]. / Les effets bénéfiques de la thérapie immunostimulante et antivirale sur le zona ophtalmique.

A group of 16 patients with ophthalmic zona zoster received antiviral and immunostimulating treatment with Romanian specific products. Results were spectacular. The problem of the identity of the varicella and zoster viruses is discussed.

Chronic ocular zoster.

In a prospective open trial 40 patients suffering from acute herpes zoster ophthalmicus were treated with systemic acyclovir. An additional 10 patients were treated by topical acyclovir alone and dexamethasone eye-drops were administered to 5 of them to suppress ocular inflammation. In the topical treatment group the period of new skin lesion formation and progression of ocular inflammatory signs were significantly prolonged. Therapy with systemic acyclovir however resulted in a quick and complete resolution of ocular inflammation in all patients. Chronic ocular inflammation developed in 4 out of 10 patients treated with topical acyclovir. We consider chronic ocular zoster as a distinct clinical entity, possibly expressing a failing local immune response against VZV.

Acyclovir (Zovirax) ophthalmic ointment: a review of clinical tolerance.

Twenty nine published clinical trials with acyclovir (ACV) ophthalmic ointment in the treatment of herpes simplex virus (HSV) corneal disease have been reviewed in which ACV has been demonstrated to be effective in the treatment of simple dendritic ulcers, geographic ulcers, deep corneal HSV infections and ocular disease associated with herpes zoster (VZV) infection affecting the ophthalmic division of the trigeminal nerve. 998 patients were studied. The most commonly occurring adverse reactions were superficial punctate keratopathy (in 9.8% of patients) and burning or stinging on application of the ointment (4%). ACV ophthalmic ointment was first licensed for the treatment of HSV infections of the eye in September 1981. Spontaneous reports of adverse reactions to ACV ophthalmic ointment to both the UK Committee on Safety of Medicines and the Wellcome Group Adverse Reactions Reporting Centre total 43 cases. These include conjunctivitis, inflammation and pain in the treated eye. In this time it is estimated that there have been approximately one million exposures to the ointment. Thus in general use, tolerance to ACV treatment has been extremely good, and clinical trial data demonstrate that it compares favourably with alternative therapies for HSV corneal disease.