Acute Retinal Necrosis: Virological Features Using Quantitative Polymerase Chain Reaction, Therapeutic Management, and Clinical Outcomes.

Abstract

PURPOSE:

To evaluate outcomes of patients treated with intensive intravitreal therapy and to describe the evolution of quantitative real-time polymerase chain reaction (qPCR) in patients treated for acute retinal necrosis (ARN) syndrome.

DESIGN:

Retrospective observational case series.

METHODS:

This study included 25 eyes of 24 patients with ARN who were treated and followed up in 2 departments of ophthalmology in Lyon, France. Assessed outcomes included qPCR viral load profile during treatment, number of antiviral intravitreal injections (IVT), retinal detachment rate, and best-corrected visual acuity.

RESULTS:

Final visual acuity was 20/200 or less in 20% of cases; the rate of retinal detachment was 16%. Viral load kinetics changed in 3 phases: a first plateau period that was not consistent, a logarithmic decrease phase, and a negativation phase. Mean decay of the logarithm of the viral load was estimated at 0.076 per day; mean time of negativation was 56.1 days. Median IVT number was 9 (range, 0-28). Ten patients were treated with injections until the viral load was undetectable. Resistance to acyclovir was observed in a patient with a prolonged initial plateau of the viral load.

CONCLUSIONS:

Numerous and prolonged IVTs, used as adjunctive therapy, could improve the prognosis of treated patients by decreasing the risk of retinal detachment and improving visual acuity. QPCR enables monitoring of the response to treatment and can provide evidence for resistance to antiviral treatment by enabling the detection of cases with a prolonged initial plateau of viral load.

• Authors: Meriem Hafidi, Hélène Janin-Manificat, Philippe Denis, Bruce Charleux, Muriel Rabilloud, Andre Boibieux, Carole Burillon, Laurent Kodjikian, Emilie Frobert
• Journal: American journal of ophthalmology (Am J Ophthalmol) Vol. 208 Pg. 376-386 (12 2019) ISSN: 1879-1891 [Electronic] United States
• PMID: 31449790 (Publication Type: Journal Article)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Chemical References

• Antiviral Agents
• DNA, Viral
• Foscarnet
• Ganciclovir

Topics

• Adult
• Aged
• Aged, 80 and over
• Antiviral Agents (therapeutic use)
• Aqueous Humor (virology)
• Cytomegalovirus Retinitis (drug therapy, virology)
• DNA, Viral (genetics)
• Eye Infections, Viral (drug therapy, virology)
• Female
• Foscarnet (therapeutic use)
• Ganciclovir (therapeutic use)
• Herpes Simplex (drug therapy, virology)
• Herpes Zoster Ophthalmicus (drug therapy, virology)
• Herpesvirus 1, Human (genetics, isolation & purification)
• Herpesvirus 2, Human (genetics, isolation & purification)
• Herpesvirus 3, Human (genetics, isolation & purification)
• Humans
• Intravitreal Injections
• Male
• Middle Aged
• Real-Time Polymerase Chain Reaction
• Retinal Necrosis Syndrome, Acute (drug therapy, virology)
• Retrospective Studies
• Viral Load (physiology)
• Visual Acuity (physiology)
• Young Adult