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Progressive outer retinal necrosis in immunocompetent patients treated initially for optic neuropathy with systemic corticosteroids.
- Source :
-
American journal of ophthalmology [Am J Ophthalmol] 2003 Apr; Vol. 135 (4), pp. 551-3. - Publication Year :
- 2003
-
Abstract
- Purpose: To report two cases of progressive outer retinal necrosis occurring in immunocompetent individuals after treatment with corticosteroids for presumed optic neuropathy.<br />Design: Observational case report.<br />Setting: University-based tertiary eye hospital.<br />Methods: Retrospective review of existing clinical records.<br />Results: Two patients were treated empirically with systemic corticosteroids for suspected inflammatory papillopathy. Subsequently, both were diagnosed with necrotizing herpetic retinitis with features of progressive outer retinal necrosis. Anterior chamber paracentesis confirmed varicella-zoster infection. Both patients were human immunodeficiency virus negative; one patient with rheumatoid arthritis was taking etanercept. Both became completely blind in one eye despite intensive treatment with antiviral medication intravenously and intravitreally.<br />Conclusions: Progressive outer retinal necrosis is not confined to patients with underlying severe immunodeficiency, such as acquired immune deficiency syndrome. Initial treatment of acute, unexplained vision loss with systemic corticosteroids may lead to catastrophic visual loss in patients with evolving necrotizing herpetic retinopathy.
- Subjects :
- Acyclovir therapeutic use
Aged
Antiviral Agents therapeutic use
Aqueous Humor virology
Blindness etiology
DNA, Viral analysis
Drug Therapy, Combination
Female
Foscarnet therapeutic use
Ganciclovir therapeutic use
Herpes Zoster Ophthalmicus diagnosis
Herpes Zoster Ophthalmicus drug therapy
Herpesvirus 3, Human genetics
Herpesvirus 3, Human isolation & purification
Humans
Middle Aged
Multiple Sclerosis diagnosis
Optic Neuritis diagnosis
Polymerase Chain Reaction
Pupil Disorders diagnosis
Pupil Disorders drug therapy
Retinal Necrosis Syndrome, Acute diagnosis
Retinal Necrosis Syndrome, Acute drug therapy
Retrospective Studies
Glucocorticoids therapeutic use
Herpes Zoster Ophthalmicus etiology
Immunocompromised Host
Optic Neuritis drug therapy
Prednisone therapeutic use
Retinal Necrosis Syndrome, Acute etiology
Subjects
Details
- Language :
- English
- ISSN :
- 0002-9394
- Volume :
- 135
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- American journal of ophthalmology
- Publication Type :
- Academic Journal
- Accession number :
- 12654381
- Full Text :
- https://doi.org/10.1016/s0002-9394(02)01978-5