Progressive outer retinal necrosis: Difference between revisions

Latest revision as of 18:43, 13 February 2021

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

@@ Line 1: / Line 1: @@
-== Background ==
+==Background==
-* On the spectrum of [[necrotizing herpetic retinopathy]], with [[acute retinal necrosis]] on the other end of the spectrum
+*On the spectrum of [[necrotizing herpetic retinopathy]], with [[acute retinal necrosis]] on the other end of the spectrum
-=== Microbiology ===
+===Microbiology===
-* Overwhelmingly caused by [[varicella-zoster virus]], followed by [[herpes simplex virus]] and rarely by [[cytomegalovirus]]
+*Overwhelmingly caused by [[varicella-zoster virus]], followed by [[herpes simplex virus]] and rarely by [[cytomegalovirus]]
-=== Epidemiology ===
+===Epidemiology===
-* Most closely associated with advanced HIV (typically with CD4 counts less than 50-100)
+*Most closely associated with advanced HIV (typically with CD4 counts less than 50-100)
-== Clinical Manifestions ==
+==Clinical Manifestions==
-* Rapidly progressing necrosis of the outer retina, in an immunocompromised patient
+*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
+*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 have concurrent cutaneous or central nervous system involvement
-* May appear similar to [[central retinal arterial occlusion]]
+*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]]
 [[Category:Herpesviridae]]