Progressive outer retinal necrosis
From IDWiki
Background
- On the spectrum of necrotizing herpetic retinopathy, with acute retinal necrosis on the other end of the spectrum
Microbiology
- Overwhelmingly caused by varicella-zoster virus, followed by herpes simplex virus and rarely by cytomegalovirus
Epidemiology
- Most closely associated with advanced HIV (typically with CD4 counts less than 50-100)
Clinical Manifestions
- Rapidly progressing necrosis of the outer retina, in an immunocompromised patient
- 22% have past medical history of cutaneous zoster, half of which had it in a V1 distribution
- May have concurrent cutaneous or central nervous system involvement
- May appear similar to central retinal arterial occlusion
Prognosis
- Poor, which most patients becoming blind despite treatment
- Vision is better if they get intravitreal injections
Management
- Consult Ophthalmology
- Ganciclovir may be more effective than acyclovir
- Should get concomitant intravitreal ganciclovir or foscarnet