Herpes simplex virus type 2 mediated acute retinal necrosis in a pediatric population: case series and review
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MEDICAL OPHTHALMOLOGY
Herpes simplex virus type 2 mediated acute retinal necrosis in a pediatric population: case series and review Ruwan A. Silva & Audina M. Berrocal & Darius M. Moshfeghi & Mark S. Blumenkranz & Steven Sanislo & Janet L. Davis
Received: 23 July 2012 / Revised: 6 September 2012 / Accepted: 17 September 2012 / Published online: 5 October 2012 # Springer-Verlag Berlin Heidelberg 2012
Abstract Background We report 15 eyes with herpes simples virus type 2 (HSV-2) mediated acute retinal necrosis (ARN) in order to better characterize pathogenesis, clinical course, diagnosis, and outcomes of the disease. Methods Retrospective observational case series of 14 patients (15 eyes) all aged 21 years or younger with acute retinal necrosis resulting from HSV-2 and examined between 1995 and 2009. Patients were diagnosed by various techniques, including polymerase chain reaction (PCR) of aqueous, vitreous, and serum, antibody determination of serum and intraocular fluids, fundoscopic exam, a therapeutic trial of antivirals active against HSV-2, or a combination thereof. Results Mean age of presentation was 11.7 years (range, newborn to 21.0 years) with a standard deviation of 7.0 years. Mean initial vision was 20/200 (median, 20/400; range, 20/20 to LP). Eleven patients (73.3 %) had received oral, injectable, or topical corticosteroids, and 14 (93.3 %) had received antiviral therapy. All patients were diagnosed based on evaluation of intraocular fluids and tissue by antibody determinations, culture, PCR, histopathologic
Institutional review board approval was obtained from the Schools of Medicine of both the University of Miami and Stanford University. R. A. Silva : D. M. Moshfeghi : M. S. Blumenkranz : S. Sanislo Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA R. A. Silva : A. M. Berrocal : J. L. Davis (*) Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, FL 33136, USA e-mail: [email protected]
examination, or a combination thereof. Mean final visual acuity was 20/400 (median, CF; range, 20/25 to LP) with worsened visual acuity in five eyes (33.3 %). Anatomically, 14 of 15 eyes had healed or improved retinal appearance. Conclusions In a pediatric population with acute retinal necrosis, HSV-2 should be considered as the prime candidate virus. Diagnosis of HSV-2 acute retinal necrosis is accomplished mainly by PCR of ocular specimens. Prompt diagnosis may lead to appropriate anti-viral therapy. Keywords Herpes simplex virus type 2 . Acute retinal necrosis . PCR . Antivirals . Steroids
Introduction Acute retinal necrosis (ARN) syndrome is a necrotizing retinopathy characterized by discrete, rapidly progressive areas of circumferential retinal necrosis against a background of uveitis, vitritis, and retinal vasculitis [1]. Though etiology in individual cases is often uncertain, varicella zoster virus (VZV) is implicated in up to 80 % of cases, with the remainder of cases attributed to herpes simplex virus type 1 (HSV-
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