Progressive outer retinal necrosis

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