First Author: M.Ohn UK
Co Author(s): M. Raja C. Goldsmith B. Burton
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To identify the feature of inflammatory deposits at the vitreoretinal interface by using optical coherence tomography and confocal imaging technique in cases of vitritis secondary to acute retinal necrosis caused by herpes zoster virus.
Cases of acute retinal necrosis with vitritis caused by herpes zoster virus were studied by using spectral domain OCT, confocal imaging and wide field fundus camera in a unit for the period of one year.
It was a prospective observational study. Cases were identified and confirmed as herpes-related acute retinal necrosis by using PCR of the vitreous sample. Cases were treated with intravitreal foscarnet twice a week for three weeks and oral valciclovir. The inflammatory precipitates at the vitreoretinal interface were observed by using the imaging technique including OCT, Confocal Imaging and wide field fundus camera and studied the progress.
There were pre-retinal inflammatory precipitates at the vitreoretinal interface especially along the retinal blood vessels in cases of Acute Retinal Necrosis caused by herpes zoster virus. We came across three cases of PCR proven herpes zoster related acute retinal necrosis within the study period and the findings were consistently the same. All three cases improved with treatment of intravitreal foscarnet and oral valciclovir. Out of three cases, two cases had had significant visual outcome with final visual acuity 6/9 or better. One case had recurrence. The unusual findings at OCT and confocal imaging at the retina during the phase of active and heavy vitritis had improved without permanent consequences in those specific retinal areas or near the retinal blood vessels. The findings at imaging improved along with the clinical improvement.
Pre-retinal inflammatory precipitates are identified at the vitreoretinal interface in cases of Acute Retinal Necrosis with Vitritis caused by herpes zoster virus by using OCT and confocal imaging. There were a few reported cases with similar findings however, it is not clear which group of uveitis can present with similar feature at imaging. This finding could be useful in identifying the disease progress if the patient could be assessed by using similar imaging technique in series or the finding might be one of the diagnostic tools. According to our experience, acute retinal necrosis caused by herpes zoster virus well responded to the treatment with intravitreal foscarnet and oral valciclovir even in immunodeficient patients.