RESUMO
PURPOSE: To report the detection of retinitis in the second eye of a patient with viral acute retinal necrosis (ARN), before the appearance of clinical change, using swept-source optical coherence tomography. RESULTS: A 63 year-old male developed right-sided varicella-zoster virus (VZV) ARN, confirmed with aqueous sampling. High-dose intravenous aciclovir caused renal impairment and was suspended for two-days. One day later, left eye macular SS-OCT revealed focal retinal thickening and disruption of retinal architecture without clinically detectable retinitis. The patient was asymptomatic. Aqueous sampling was VZV PCR positive. He received bilateral foscarnet injections and renal adjusted dose of aciclovir. The left OCT signs improved with full restoration of retinal layers. CONCLUSIONS: We report for the first time the use of OCT to detect pre-clinical second eye retinitis during ARN. Prompt diagnosis and combined systemic and intensive local antiviral therapy resulted in a favourable structural and functional outcome.
Assuntos
Infecções Oculares Virais , Síndrome de Necrose Retiniana Aguda , Infecções Oculares Virais/diagnóstico , Infecções Oculares Virais/tratamento farmacológico , Foscarnet/uso terapêutico , Herpesvirus Humano 3/genética , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome de Necrose Retiniana Aguda/diagnóstico , Síndrome de Necrose Retiniana Aguda/tratamento farmacológico , Tomografia de Coerência ÓpticaRESUMO
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.
Assuntos
Aciclovir/uso terapêutico , Infecções Oculares Virais/tratamento farmacológico , Foscarnet/uso terapêutico , Herpes Zoster Oftálmico/tratamento farmacológico , Síndrome de Necrose Retiniana Aguda/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antivirais/uso terapêutico , DNA Viral/análise , Infecções Oculares Virais/diagnóstico , Feminino , Seguimentos , Herpes Zoster Oftálmico/diagnóstico , Herpesvirus Humano 3/genética , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome de Necrose Retiniana Aguda/diagnóstico , Estudos Retrospectivos , Resultado do Tratamento , Acuidade VisualRESUMO
BACKGROUND: The current outbreak of COVID-19 has spread rapidly all over the world. Respiratory droplets and contaction with infected patients are the two major transmission routes. However, the value of tear virus nucleic acid is still not clear. We dynamic detected the SARS-CoV-2 in eye sample of one COVID-19 patient with obstruction of common lacrimal ducts. METHODS: Besides the routine examination, nasopharyngeal and eye swab were continuously measured by polymerase chain reaction assay and next-generation sequencing (NGS). Gene detection was performed for drug use guidance, and flow cytometry was performed to analyse the lymphocyte subsets. RESULTS: Nasopharyngeal swabs were positive for 22 days, but eye swabs were still continuously positive for 2 weeks after nasopharyngeal swabs turned negative. The low level of lymphocyte and the high level IL-6 lasted for almost 4 weeks, then became near normal. Next-generation sequencing (NGS) confirmed the existing of SARS-CoV-2, HSV1 and HHV6B virus nucleic acid. The gene detection for drug use guidance showed the genetic locus ABCB1 (3435T>C) rs1045642 belonged to type CC and it mean the efficiency of lopinavir-ritonavir would be significantly decreased. The flow cytometry of lymphocyte subsets showed PD-1+ CD95+ cells was accounting for 94.8% in CD3+ CD8+ T subset and for 94.8% in CD3+ TCRγδ+ T subset. CONCLUSIONS: As obstruction of common lacrimal duct, positively detection in one eye for 2 weeks more after nasopharyngeal swab became negative. More eye swabs should be collected from COVID-19 patients, especially from those immunocompromised, those with eye symptoms and those had a history of ocular diseases.
Assuntos
COVID-19/diagnóstico , Túnica Conjuntiva/virologia , Infecções Oculares Virais/diagnóstico , Herpesvirus Humano 1/isolamento & purificação , Herpesvirus Humano 6/isolamento & purificação , Obstrução dos Ductos Lacrimais/diagnóstico , SARS-CoV-2/isolamento & purificação , Lágrimas/virologia , Idoso , Antibacterianos/uso terapêutico , COVID-19/virologia , Conjuntivite Viral/diagnóstico , Quimioterapia Combinada , Infecções Oculares Virais/tratamento farmacológico , Infecções Oculares Virais/virologia , Citometria de Fluxo , Inibidores da Protease de HIV/uso terapêutico , Herpes Simples/diagnóstico , Herpes Simples/tratamento farmacológico , Herpes Simples/virologia , Herpesvirus Humano 1/genética , Herpesvirus Humano 6/genética , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Obstrução dos Ductos Lacrimais/tratamento farmacológico , Obstrução dos Ductos Lacrimais/virologia , Lopinavir/uso terapêutico , Masculino , Medicina Tradicional Chinesa , Moxifloxacina/uso terapêutico , Nasofaringe/virologia , Ácidos Nucleicos/genética , Reação em Cadeia da Polimerase , RNA Viral/genética , Ritonavir/uso terapêutico , Infecções por Roseolovirus/diagnóstico , Infecções por Roseolovirus/tratamento farmacológico , Infecções por Roseolovirus/virologia , SARS-CoV-2/genética , Tratamento Farmacológico da COVID-19RESUMO
PURPOSE: To report safety and tolerability of a one-time administration of ophthalmic 5% povidone-iodine (5% PVP-I) in a double-masked randomized trial for the treatment of adenoviral conjunctivitis (Ad-Cs). METHODS: Of 212 participants screened, 56 eligible participants with red eye symptoms ≤4 days and a positive adenoviral rapid immunoassay were randomized to a one-time administration of ophthalmic 5% PVP-I or preservative free artificial tears (AT). Safety was assessed by corneal fluorescein staining (baseline, immediate post-administration and Day 1) and visual acuity (VA) (baseline and Day 1). Tolerability was assessed using participant-rated overall ocular discomfort (baseline, immediately post-administration and on Day 1. RESULTS: In the 5% PVP-I group, corneal staining increased immediately post-administration but returned to baseline levels by Day 1. There was no change in VA between baseline and Day 1 in either 5% PVP-I or AT groups (pâ¯=â¯0.87). In the 5% PVP-I group, there was no change in participant-rated overall discomfort immediately post-administration (pâ¯=â¯0.78) or on day 1 (pâ¯=â¯0.10) compared to baseline. In the AT group, participant-rated overall discomfort was lower immediately post-administration but returned to baseline levels by Day 1. One adverse event was reported in the 5% PVP-I group on Day 1-2 that was classified as not related to treatment. CONCLUSION: These results suggest ophthalmic 5% PVP-I used as a one-time treatment is safe and well tolerated by patients with Ad-Cs.
Assuntos
Infecções por Adenoviridae/tratamento farmacológico , Conjuntivite/tratamento farmacológico , Infecções Oculares Virais/tratamento farmacológico , Lubrificantes Oftálmicos , Povidona-Iodo/administração & dosagem , Acuidade Visual , Adulto , Conjuntivite/virologia , Relação Dose-Resposta a Droga , Método Duplo-Cego , Esquema de Medicação , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Resultado do TratamentoRESUMO
INTRODUCTION: Cornea ulceration and infectious keratitis are leading causes of corneal morbidity and blindness. Infectious causes are among the most frequent and most severe. Management strategies for bacterial corneal ulcers have changed significantly over the last decades, however with a more limited progress in the treatment and management of nonbacterial, infectious ulcers. AREAS COVERED: This paper provides an overview of the current principles, strategies and treatment choices for infectious corneal ulcers in adults. EXPERT OPINION: Topical application with a broad-spectrum antimicrobial remains the preferred method for the pharmacological management of infectious corneal ulcers. Increasing reports of clinical failures and in vitro resistance to antibiotics to treat the most common infectious (bacterial) corneal ulcers are increasing concerns. New approaches for improvement in the pharmacological management of corneal ulcers should focus on strategies for a more rational and evidence-based use of current antimicrobials and development of products to modulate the host immune response and to neutralize microbial toxins and other immune modulators.
Assuntos
Anti-Infecciosos/uso terapêutico , Úlcera da Córnea/tratamento farmacológico , Infecções Oculares/tratamento farmacológico , Ceratite/tratamento farmacológico , Administração Oftálmica , Corticosteroides/uso terapêutico , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/efeitos adversos , Anti-Infecciosos/farmacocinética , Úlcera da Córnea/diagnóstico , Úlcera da Córnea/microbiologia , Úlcera da Córnea/parasitologia , Úlcera da Córnea/virologia , Infecções Oculares/diagnóstico , Infecções Oculares/microbiologia , Infecções Oculares/parasitologia , Infecções Oculares/virologia , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções Oculares Bacterianas/microbiologia , Infecções Oculares Fúngicas/tratamento farmacológico , Infecções Oculares Fúngicas/microbiologia , Infecções Oculares Parasitárias/tratamento farmacológico , Infecções Oculares Parasitárias/parasitologia , Infecções Oculares Virais/tratamento farmacológico , Infecções Oculares Virais/virologia , Humanos , Ceratite/diagnóstico , Ceratite/microbiologia , Ceratite/parasitologia , Ceratite/virologia , Testes de Sensibilidade Microbiana , Testes de Sensibilidade Parasitária , Resultado do TratamentoRESUMO
PURPOSE: To report cases of uveitis that are associated with human herpesvirus-8 (HHV-8) and the impact of interferon-alpha therapy on their visual outcome. DESIGN: Interventional case reports. METHODS: Extensive examination was performed in patients with chronic and severe uveitis to exclude a viral cause that requires specific therapy. After histopathologic, molecular, and/or serologic confirmation of HHV-8 uveitis, interferon-alpha2a therapy (3 millions IU/d, 3 days per week, subcutaneously) was initiated. RESULTS: Two patients of Mediterranean origin were included. HHV-8 serologic result was positive in both cases. Histopathologic examination of conjunctival biopsy specimens confirmed Kaposi's sarcoma in the second case, and quantitative polymerase chain reaction identified HHV-8 DNA in the biopsy specimen. Disease was controlled by interferon-alpha2a in both cases, but maintenance therapy was mandatory to prevent relapses. CONCLUSION: HHV-8-associated uveitis is a rare condition in immunocompetent hosts. Severe and chronic conditions may require antiviral and immunomodulatory therapies. Interferon alpha seems to be a good candidate and may be proposed in these cases.
Assuntos
Infecções Oculares Virais/tratamento farmacológico , Herpesvirus Humano 8/isolamento & purificação , Interferon-alfa/uso terapêutico , Sarcoma de Kaposi/tratamento farmacológico , Uveíte/tratamento farmacológico , Idoso , Antivirais/uso terapêutico , Biópsia , Criança , Conjuntivite/patologia , Conjuntivite/virologia , DNA Viral/análise , Infecções Oculares Virais/virologia , Feminino , Herpesvirus Humano 8/genética , Humanos , Interferon alfa-2 , Reação em Cadeia da Polimerase , Proteínas Recombinantes , Sarcoma de Kaposi/virologia , Uveíte/virologiaRESUMO
La melatonina, conocida neurohormona que participa en el control de los ciclos circadianos, presenta una nueva dimensión cuando es ensayada para el tratamiento de algunas patologías oculares. En Particular, la administración de esta neurohormona permite observar una clara y prolongada disminución de la presión intraocular en los modelos animales experimentales. Este hecho es relevante por cuanto el tratamiento de la patología denominada glaucoma se lleva a cabo por medio de fármacos que reducen la presión intraocular. Otro papel relevante que lleva a cabo esta sustancia es la aceleración de la cicatrización en las heridas corneales superficiales. Aplicada en forma de colirio, la melatonina acelera la cicatrización hasta en un 165%, por lo que también podría ser empleada para facilitar la cicatrización de heridas corneales o como complemento tras las operaciones de cirugía ocular
Melatonin is a neurohormone which participates in the control of circadian cycles. This substance presents a new dimension as a drug when it is assayed for the treatment of some ocular pathologies. In particular, the administration of this compound permits to observe a clear and sustained reduction in the intraocular pressure. This is relevant fact since most of the treatments of glaucoma are based on a reduction in the ocular pressure. Another role of melatonin is the acceleration of the corneal wound healing. When topically applied, melatonin can accelerate the rate of re-epithelialisation up to 165 %, therefore this compound may be used to facilitate corneal wound healing or as a complementary drug after ocular surgery
Assuntos
Melatonina/farmacologia , Melatonina/farmacocinética , Melatonina/uso terapêutico , Pressão Intraocular , Cicatrização , Ensaio Patogenético Homeopático/farmacologia , Experimentação Animal , Glaucoma/tratamento farmacológico , Hipertensão Ocular/tratamento farmacológico , Neoplasias Oculares/tratamento farmacológico , Infecções Oculares/tratamento farmacológico , Fenômenos Fisiológicos Oculares , Fenômenos Fisiológicos Oculares , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções Oculares Virais/tratamento farmacológico , Traumatismos Oculares/tratamento farmacológico , Córnea , Doenças da Córnea/terapiaRESUMO
PURPOSE: To report the clinical features and evaluate the visual outcome of eleven cases of herpes simplex virus-2 (HSV-2) related acute retinal necrosis syndrome (ARN). DESIGN: Retrospective interventional case series. METHODS: Twelve eyes of eleven patients from two European centers, diagnosed with HSV-2 related acute retinal necrosis syndrome were retrospectively reviewed. Herpes simplex virus-2 DNA was detected by polymerase chain reaction in intraocular fluids (aqueous and/or vitreous). Findings at initial examination, clinical evolution with antiviral therapy, complications and final visual acuity were evaluated. RESULTS: Herpes simplex virus-2 DNA was detected in all cases. No sample was positive for more than one virus. The mean age of disease in the first eye was 36 years (ranged from 10 to 57 years). Five patients were women and six were men. All patients were immunocompetent. Previous medical history included neonatal herpes (n = 1), previous ARN (n = 3), trauma (n = 1) and systemic corticosteroid administration before occurrence of ARN (n = 3). Preexisting pigmented chorioretinal scars were found in three cases. Patients were treated with high dose intravenous acyclovir or foscarnet +/- intravitreal ganciclovir +/- interferon. The mean follow-up was 14.5 months (from 5 to 22 months). At the end of the follow-up period, five eyes (41.7%) showed improvement of visual acuity of two or more lines. Final visual acuity was 20/60 or better in four eyes (33.3%), 20/400 or better in four eyes (33.3%) and less than 20/400 in four eyes. CONCLUSION: History of neonatal herpes, triggering events such as neurosurgery, periocular trauma, high-dose corticosteroids, and chorioretinal scars suggest that HSV-2 retinitis reflects reactivation of HSV-2 infection.
Assuntos
Infecções Oculares Virais/virologia , Herpes Simples/virologia , Herpesvirus Humano 2/isolamento & purificação , Síndrome de Necrose Retiniana Aguda/virologia , Aciclovir/uso terapêutico , Adulto , Antivirais/uso terapêutico , Humor Aquoso/virologia , Criança , DNA Viral/análise , Quimioterapia Combinada , Infecções Oculares Virais/diagnóstico , Infecções Oculares Virais/tratamento farmacológico , Feminino , Foscarnet/uso terapêutico , Ganciclovir/uso terapêutico , Herpes Simples/diagnóstico , Herpes Simples/tratamento farmacológico , Herpesvirus Humano 2/genética , Humanos , Interferons/uso terapêutico , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Síndrome de Necrose Retiniana Aguda/diagnóstico , Síndrome de Necrose Retiniana Aguda/tratamento farmacológico , Estudos Retrospectivos , Ativação Viral , Acuidade Visual , Corpo Vítreo/virologiaRESUMO
To determine the antiviral effects of compounds against ocular adenovirus (AdV) infection, we established an animal model of AdV infection in cotton rat eyes. Cotton rat eyes were inoculated intrastromally and topically with four AdV serotypes 4, 5, 8, and 37, and treated topically with 1% HPMPC (cidofovir) eye drops twice a day. The infected corneas were extracted and homogenized, and virus titers in the cornea specimens were determined by a plaque assay. The virus titer in AdV type 5-inoculated eyes peaked on days 0 through 3 after inoculation and virus shedding was detected for 18.0+/-2.8 days. AdV 5 antigen in the infected corneas was demonstrated in the corneal epithelial cells by immunofluorescence stain. However, for AdV serotypes 4, 8, and 37, no evidence of continued virus replication in cotton rat eyes was noted. Specimens from cidofovir-treated eyes infected with AdV 5 demonstrated a statistically significant reduction in the mean virus titer (days 3-15) (P=0.028) and virus shedding duration (P=0.0014), as compared with those of the control group.
Assuntos
Infecções por Adenoviridae/tratamento farmacológico , Adenovírus Humanos/efeitos dos fármacos , Antivirais/uso terapêutico , Citosina/análogos & derivados , Citosina/uso terapêutico , Infecções Oculares Virais/tratamento farmacológico , Organofosfonatos , Compostos Organofosforados/uso terapêutico , Infecções por Adenoviridae/virologia , Adenovírus Humanos/crescimento & desenvolvimento , Administração Tópica , Animais , Antígenos Virais/análise , Antivirais/farmacologia , Cidofovir , Conjuntivite Viral/tratamento farmacológico , Córnea/virologia , Citosina/administração & dosagem , Citosina/farmacologia , Modelos Animais de Doenças , Avaliação Pré-Clínica de Medicamentos , Feminino , Compostos Organofosforados/administração & dosagem , Compostos Organofosforados/farmacologia , Ratos , Sigmodontinae , Ensaio de Placa Viral , Replicação Viral/efeitos dos fármacos , Eliminação de Partículas Virais/efeitos dos fármacosAssuntos
Ceratite Herpética/etiologia , Fototerapia/efeitos adversos , Ativação Viral , Aciclovir/administração & dosagem , Administração Tópica , Antivirais/administração & dosagem , Infecções Oculares Virais/tratamento farmacológico , Infecções Oculares Virais/etiologia , Feminino , Humanos , Ceratite Herpética/tratamento farmacológico , Pessoa de Meia-IdadeRESUMO
PURPOSE: To determine the incidence, pathophysiology, clinical outcome, and survival in patients with clinically resistant retinitis. METHODS: Cytomegalovirus (CMV) retinitis was prospectively studied in 100 patients with acquired immune deficiency syndrome (AIDS). In 11 of these patients, clinically resistant retinitis developed, defined as new activity or progression, despite at least 8 consecutive weeks of induction doses of either foscarnet or ganciclovir. Fundus photography, pharmacokinetics, CMV cultures and sensitivities, and survival analyses were studied. The therapeutic interventions attempted after clinically resistant retinitis was identified included continuing a high dose (induction level) of the same antiviral drug, changing the antiviral drug, and combining antiviral therapy with foscarnet and ganciclovir. RESULTS: Clinically resistant retinitis occurred in 11 (11%) of 100 patients with CMV retinitis and appeared to be a manifestation of acquired CMV antiviral drug resistance. Drug metabolism and pharmacokinetics in these patients were normal. The use of combination therapy with foscarnet and ganciclovir was effective in halting the progression of retinitis in three (75%) of four patients (6 of 7 eyes able to be evaluated) receiving combination therapy. CONCLUSION: Clinically resistant retinitis is a manifestation of infection by CMV that has acquired drug resistance. In these patients, combination antiviral drug treatment should be considered. It is likely that clinically resistant retinitis will become more frequent as patients with CMV retinitis and AIDS survive longer.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções por Citomegalovirus/tratamento farmacológico , Infecções Oculares Virais/tratamento farmacológico , Ganciclovir/uso terapêutico , Retinite/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/fisiopatologia , Adulto , Citomegalovirus/efeitos dos fármacos , Infecções por Citomegalovirus/fisiopatologia , Resistência Microbiana a Medicamentos , Quimioterapia Combinada , Infecções Oculares Virais/fisiopatologia , Feminino , Foscarnet/farmacocinética , Foscarnet/uso terapêutico , Fundo de Olho , Ganciclovir/farmacocinética , Humanos , Masculino , Testes de Sensibilidade Microbiana , Estudos Prospectivos , Retinite/microbiologia , Retinite/fisiopatologia , Taxa de Sobrevida , Acuidade VisualAssuntos
Síndrome da Imunodeficiência Adquirida , Antivirais/uso terapêutico , Infecções por Citomegalovirus/tratamento farmacológico , Infecções Oculares Virais/tratamento farmacológico , Rotulagem de Alimentos/legislação & jurisprudência , Hidrocortisona/provisão & distribuição , Ácido Fosfonoacéticos/análogos & derivados , Retinite/tratamento farmacológico , Foscarnet , Humanos , Medicamentos sem Prescrição/provisão & distribuição , Ácido Fosfonoacéticos/uso terapêutico , Retinite/microbiologia , Estados Unidos , United States Food and Drug AdministrationRESUMO
Infections caused by cytomegalovirus (CMV) resistant in vitro to ganciclovir, defined as requiring greater than 6 mumols of ganciclovir for ED50 have developed in some AIDS patients with progressive CMV retinitis despite chronic ganciclovir therapy. Two such patients (CMV isolates ED50, 9.5-14.5 mumols) were treated with foscarnet, an antiviral pyrophosphate analogue to which both patients' isolates demonstrated in vitro susceptibility (ED50, less than or equal to 300 mumols). Each patient had documented retinitis progression, at 2- and 1- to 5-week intervals, respectively, despite high-dose intravenous ganciclovir therapy. Both patients responded to foscarnet therapy with cessation of viral shedding in urine and blood. After foscarnet therapy was started, retinitis stabilized in the two patients for 12 and 25 weeks, respectively, before progression recurred. Therefore, foscarnet may be effective in immunocompromised patients with rapidly progressive CMV retinitis whose CMV isolates have developed in vitro resistance to ganciclovir.