acyclovir and Eye-Infections--Viral

To report a rare case of herpes virus type 2-related conjunctivitis, resistant to aciclovir (ACV).. Case report and review of literature.. A 28-year-old human immunodeficiency virus-positive man presented with chronic, recurrent follicular conjunctivitis. Multiplex reverse transcription polymerase chain reaction assay testing was positive for herpes simplex virus (HSV); subsequent typing with HSV assay revealed the presence of HSV type 2. Oral ACV failed to control the disease, and the patient continued to worsen clinically until resistance testing was performed. This revealed an M183stop within thymidine kinase, thus confirming the suspected resistance. The patient improved after 14 days of high-dose continuous intravenous infusion of ACV.. This is a rare case of isolated conjunctivitis due to herpes virus type 2, in an human immunodeficiency virus-positive patient, which was found to be resistant to ACV. Drug-resistant HSV is likely to emerge as an important clinical entity in the future, increasing the need for new drugs with novel mechanisms of action.

Topics: Acyclovir; Adult; Antiviral Agents; Conjunctivitis; Drug Resistance, Viral; Eye Infections, Viral; Herpes Simplex; Herpesvirus 1, Human; Humans; Male; Microbial Sensitivity Tests; RNA, Viral

Topics: Abducens Nerve Diseases; Acyclovir; Aged; Antiviral Agents; Cranial Nerve Diseases; Epithelium, Corneal; Eye Infections, Viral; Female; Glucocorticoids; Herpes Zoster Ophthalmicus; Humans; Male; Ocular Motility Disorders; Oculomotor Nerve Diseases; Optic Nerve Diseases; Orbital Diseases; Prednisolone; Trigeminal Nerve Diseases; Trochlear Nerve Diseases

To review recent advancements in the management of herpes simplex virus (HSV) epithelial keratitis.. Trifluridine eye drop, acyclovir (ACV) ointment, ganciclovir gel, and oral ACV are still the main therapeutic agents. Cryopreserved amniotic membrane has been recently used as an adjuvant treatment. Resistance to ACV has become a concerning issue. The animal models of HSV vaccine are able to reduce HSV keratitis. New antivirals are under development.. Current cases of HSV epithelial keratitis are manageable with available medications, but new advancements are required to decrease disease burden in the future. HSV vaccine can be revolutionary.

Topics: Acyclovir; Administration, Oral; Animals; Antiviral Agents; Disease Models, Animal; Epithelial Cells; Epithelium, Corneal; Eye Infections, Viral; Ganciclovir; Humans; Keratitis, Herpetic; Ointments; Ophthalmic Solutions; Trifluridine

The purpose of this review is to discuss the options for, and recent developments in, the surgical treatment of herpes keratitis. Although the mainstay of treatment of herpetic keratitis is topical or oral antiviral agents, surgical intervention may be necessary for corneal melting or long-term complications such as scarring, lipid keratopathy, necrotizing keratitis, and neurotrophic keratitis.. There are a number of surgical therapies available for herpes keratitis. Preferred therapeutic modalities differ based on the size, causation, and location of the infection but consist of either replacement of the infected tissue or structural support of the tissue to allow healing. Incremental improvements in the existing treatment modalities have made them more effective, easier, and safer, whereas novel therapies such as corneal neurotization are starting to be described in ophthalmic literature.. Several options are available for surgically managing the complications of herpes keratitis. Ophthalmologists should select the optimal procedure based on the individual patient's situation. VIDEO ABSTRACT: http://links.lww.com/COOP/A28.

Topics: Acyclovir; Antiviral Agents; Eye Infections, Viral; Humans; Keratitis, Herpetic; Ophthalmologic Surgical Procedures

To define a clinically tailored therapeutic strategy for the treatment of viral anterior uveitis (VAU).. A PubMed search spanning the past 5 years was conducted using the MesH-terms "viral anterior uveitis" and "therapy.". The herpes simplex virus (HSV), the varicella zoster virus (VZV), and the cytomegalovirus (CMV) are the predominant pathogens in VAU. Other viruses, including rubella, chikungunya, and zika, have been linked with distinct forms of the disease. Depending on the causative agent and the host immunocompetence, the mainstay treatment for suspected VAU is a combination of topical or systemic antivirals and topical corticosteroids, supplemented with cycloplegics and intraocular-pressure-lowering medication.. Oral acyclovir, valacyclovir, and famciclovir are the mainstay of treatment for HSV- and VZV-induced infections. Brivudin serves as an alternative in insufficiently responsive cases. CMV-induced infections respond well to valganciclovir. A 3- to 12-month course of prophylactic treatment against recurrences is worth considering.

Topics: Acyclovir; Antiviral Agents; Bromodeoxyuridine; Chikungunya Fever; Cytomegalovirus Infections; Eye Infections, Viral; Famciclovir; Herpes Simplex; Herpes Zoster Ophthalmicus; Humans; Rubella; Uveitis, Anterior; Valacyclovir; Zika Virus Infection

We report three cases of patients with developmental-delay from neonatal herpetic encephalitis and/or meningitis who presented years later with acute retinal necrosis due to herpes simplex virus. The diagnosis was delayed in all cases due to the patients' inability to verbalize their ocular complaints and cooperate with eye examinations. This case series documents the clinical course, pathophysiologic mechanism, and treatment of acute retinal necrosis in this patient population. Clinicians should understand the importance of prudent consideration of acute retinal necrosis in patients with a history of neonatal herpetic encephalitis and/or meningitis presenting with a red eye.

Topics: Acyclovir; Adult; Antibodies, Viral; Antiviral Agents; Child; Developmental Disabilities; DNA, Viral; Drug Combinations; Encephalitis, Herpes Simplex; Eye Infections, Viral; Glucocorticoids; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Simplexvirus; Virus Activation; Vitreous Body

To evaluate the available evidence in peer-reviewed publications about the diagnosis and treatment of acute retinal necrosis (ARN).. Literature searches of the PubMed and Cochrane Library databases were last conducted on July 27, 2016. The searches identified 216 unique citations, and 49 articles of possible clinical relevance were reviewed in full text. Of these 49 articles, 27 were deemed sufficiently relevant or of interest, and they were rated according to strength of evidence. An additional 6 articles were identified from the reference lists of these articles and included. All 33 studies were retrospective.. Polymerase chain reaction (PCR) testing of aqueous or vitreous humor was positive for herpes simplex virus (HSV) or varicella zoster virus (VZV) in 79% to 100% of cases of suspected ARN. Aqueous and vitreous specimens are both sensitive and specific. There is level II and III evidence supporting the use of intravenous and oral antiviral therapy for the treatment of ARN. Data suggest that equivalent plasma drug levels of acyclovir can be achieved after administration of oral valacyclovir or intravenous acyclovir. There is level II and III evidence suggesting that the combination of intravitreal foscarnet and systemic antiviral therapy may have greater therapeutic efficacy than systemic therapy alone. The effectiveness of prophylactic laser or early pars plana vitrectomy (PPV) in preventing retinal detachment (RD) remains unclear.. Polymerase chain reaction testing of ocular fluid is useful in supporting a clinical diagnosis of ARN, but treatment should not be delayed while awaiting PCR results. Initial oral or intravenous antiviral therapy is effective in treating ARN. The adjunctive use of intravitreal foscarnet may be more effective than systemic therapy alone. The role of prophylactic laser retinopexy or early PPV is unknown at this time.

Topics: Academies and Institutes; Acyclovir; Antiviral Agents; Aqueous Humor; Biomedical Technology; DNA, Viral; Eye Infections, Viral; Foscarnet; Herpes Simplex; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Ophthalmology; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Simplexvirus; United States; Valacyclovir; Valine; Vitrectomy; Vitreous Body

Acute retinal necrosis (ARN), also known as Kirisawa-type uveitis, is an uncommon condition caused by infection of the retina by one of the herpes family of viruses, most typically varicella zoster virus or herpes simplex virus and less commonly cytomegalovirus. Clinical diagnosis can be challenging and is often aided by PCR-based analysis of ocular fluids. Treatment typically involves extended use of one or more antiviral agents. Long term retinal detachment risk is high. We review the literature on ARN and present an approach to the diagnosis and management of this serious condition.

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Cytomegalovirus Retinitis; Eye Infections, Viral; Famciclovir; Fluorescein Angiography; Ganciclovir; Herpes Simplex; Humans; Laser Coagulation; Retinal Necrosis Syndrome, Acute; Valacyclovir; Valganciclovir; Valine

Necrotising fasciitis is a rare severe infection of the soft tissues and deep fascia, which is associated with a significant level of mortality. Involvement of the head and neck is uncommon, and necrotising fasciitis of the periorbital area even rarer. We present a case of bilateral periorbital necrotising fasciitis following shingles in an otherwise healthy immunocompetent patient.

Topics: Acyclovir; Debridement; Eye Infections, Viral; Eyelid Diseases; Fasciitis, Necrotizing; Female; Follow-Up Studies; Herpes Zoster; Herpesvirus 3, Human; Humans; Middle Aged; Rare Diseases; Severity of Illness Index; Treatment Outcome

Childhood infectious diseases are not usually serious. The symptoms (fever, conjunctivitis, itching) diminish with the administration of antipyretic drugs. Cutaneous lesions leave no scarring. Sometimes complications may appear.

Topics: Acyclovir; Administration, Cutaneous; Antiviral Agents; Chickenpox; Child; Chorioretinitis; Conjunctivitis, Viral; Drug Therapy, Combination; Eye Infections, Viral; Glucocorticoids; Humans; Measles; Mumps; Pruritus; Rubella; Skin Diseases, Viral; Treatment Outcome

Acute retinal necrosis (ARN) is known to occur in conjunction with primary varicella or chickenpox infection. The majority of ARN cases reported in the literature were of milder form with mild to moderate vitritis, limited retinitis, and rare occurrence of retinal breaks or detachment that responded well to intravenous acyclovir, with or without oral prednisolone. We report a case of unilateral ARN with marked vitritis and retinal necrosis leading to retinal breaks following chickenpox in a 32-year-old healthy lady. This patient was successfully treated with intravenous acyclovir followed by oral acyclovir and orbital floor triamcinolone injections to contain the inflammation with barrier laser therapy to secure the retinal breaks with good visual outcome. This case is unusual in its severity, and to our knowledge, orbital floor triamcinolone therapy was not used earlier to contain ARN inflammation.

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Dexamethasone; Drug Therapy, Combination; Eye Infections, Viral; Female; Glucocorticoids; Humans; Parasympatholytics; Retinal Necrosis Syndrome, Acute; Treatment Outcome; Triamcinolone; Tropanes; Visual Acuity

Topics: Acyclovir; Adrenal Cortex Hormones; Antiviral Agents; Drug Therapy, Combination; Eye Infections, Viral; Herpes Simplex; Herpes Zoster; Humans; Valacyclovir; Valine; Vitrectomy

To report the clinical features and evaluate the visual outcome of eleven cases of herpes simplex virus-2 (HSV-2) related acute retinal necrosis syndrome (ARN).. Retrospective interventional case series.. Twelve eyes of eleven patients from two European centers, diagnosed with HSV-2 related acute retinal necrosis syndrome were retrospectively reviewed. Herpes simplex virus-2 DNA was detected by polymerase chain reaction in intraocular fluids (aqueous and/or vitreous). Findings at initial examination, clinical evolution with antiviral therapy, complications and final visual acuity were evaluated.. Herpes simplex virus-2 DNA was detected in all cases. No sample was positive for more than one virus. The mean age of disease in the first eye was 36 years (ranged from 10 to 57 years). Five patients were women and six were men. All patients were immunocompetent. Previous medical history included neonatal herpes (n = 1), previous ARN (n = 3), trauma (n = 1) and systemic corticosteroid administration before occurrence of ARN (n = 3). Preexisting pigmented chorioretinal scars were found in three cases. Patients were treated with high dose intravenous acyclovir or foscarnet +/- intravitreal ganciclovir +/- interferon. The mean follow-up was 14.5 months (from 5 to 22 months). At the end of the follow-up period, five eyes (41.7%) showed improvement of visual acuity of two or more lines. Final visual acuity was 20/60 or better in four eyes (33.3%), 20/400 or better in four eyes (33.3%) and less than 20/400 in four eyes.. History of neonatal herpes, triggering events such as neurosurgery, periocular trauma, high-dose corticosteroids, and chorioretinal scars suggest that HSV-2 retinitis reflects reactivation of HSV-2 infection.

Topics: Acyclovir; Adult; Antiviral Agents; Aqueous Humor; Child; DNA, Viral; Drug Therapy, Combination; Eye Infections, Viral; Female; Foscarnet; Ganciclovir; Herpes Simplex; Herpesvirus 2, Human; Humans; Interferons; Male; Middle Aged; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Virus Activation; Visual Acuity; Vitreous Body

Ocular herpes simplex is usually diagnosed by its typical clinical presentation. It is generally accepted to be a unilateral disease, with lid eruptions typically occurring in primary ocular herpes simplex, while absent or mild in recurrent disease. Recurrent ocular herpes simplex is generally thought to be characterized by corneal involvement.. A 35-year-old woman had a 2-day history of a progressive bilateral, erythematous, vesicular rash of the upper and lower eyelids and associated preseptal cellulitis. She had a history of a recurrent, unilateral eyelid rash that was previously diagnosed as herpes zoster. The eyelid involvement was unusual because it was bilateral, severe, recurrent, vesicular, and isolated, with no additional ocular manifestations of herpes simplex. These atypical features are in contrast to the generally accepted manifestations of recurrent ocular herpes simplex. A cytologic evaluation and a viral culture confirmed infection by HSV Type 1.. Lid involvement occurs in recurrent ocular herpes simplex disease more often than generally accepted, while simultaneous bilateral disease is uncommon. As in this case, when atypical presentations occur, critical review of the differential diagnosis and use of laboratory tests are helpful.

Topics: Acyclovir; Administration, Oral; Adult; Antiviral Agents; Eye Infections, Viral; Eyelid Diseases; Eyelids; Female; Follow-Up Studies; Herpes Simplex; Herpesvirus 1, Human; Humans; Recurrence

Neonatal herpes simplex virus (HSV) infections limited to the skin, eyes and mouth (SEM) can result in neurologic impairment. A direct correlation exists between the development of neurologic deficits and the frequency of cutaneous HSV recurrences. Thus, the National Institutes of Allergy and Infectious Diseases Collaborative Antiviral Study Group conducted a Phase I/II trial of oral acyclovir therapy for the suppression of cutaneous recurrences after SEM disease in 26 neonates.. Infants < or = 1 month of age with virologically confirmed HSV-2 SEM disease were eligible for enrollment. Suppressive oral acyclovir therapy (300 mg/m2/dose given either twice daily or three times per day) was administered for 6 months.. Twelve (46%) of the 26 infants developed neutropenia (< 1000 cells/mm3) while receiving acyclovir. Thirteen (81%) of the 16 infants who received drug 3 times per day experienced no recurrences of skin lesions while receiving therapy. In comparison, a previous Collaborative Antiviral Study Group study found that only 54% of infants have no cutaneous recurrences in the 6 months after resolution of neonatal HSV disease if oral acyclovir suppressive therapy is not initiated. In one infant, HSV DNA was detected in the cerebrospinal fluid during a cutaneous recurrence, and an acyclovir-resistant HSV mutant was isolated from another patient during the course of the study.. Administration of oral acyclovir can prevent cutaneous recurrences of HSV after neonatal SEM disease. The effect of such therapy on neurologic outcome must be assessed in a larger, Phase III study. As such, additional investigation is necessary before routine use of suppressive therapy in this population can be recommended.

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Drug Resistance; Eye Infections, Viral; Female; Herpes Genitalis; Herpesvirus 2, Human; Humans; Infant, Newborn; Male; Mouth Diseases; Recurrence; Retrospective Studies; Skin Diseases, Viral

To evaluate the efficacy and safety of high-dose intravenous acyclovir combined with oral zidovudine as suppressive therapy for cytomegalovirus retinitis in patients with AIDS, a single-arm, outpatient, open-label, phase II pilot study was performed. Between July 1989 and July 1990, 12 men with AIDS, cytomegalovirus retinitis, and salvageable vision received intravenous acyclovir, 10 mg/kg of body weight every 8 h, and oral zidovudine after successful induction therapy with intravenous ganciclovir, 5 mg/kg every 12 h for 14 days. Patients were evaluated weekly. Ten of 12 patients were followed to the time of retinitis progression; two were withdrawn from the study because of concomitant life-threatening infection. The median duration of acyclovir and zidovudine therapy before retinitis progression occurred was 32 days. None of the eight uninvolved eyes in the 10 evaluatable patients developed cytomegalovirus retinitis during study participation. These data suggest that high-dose intravenous acyclovir with zidovudine provides some benefit in suppressing cytomegalovirus retinitis.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Administration, Oral; Adult; Cytomegalovirus Infections; Drug Evaluation; Drug Therapy, Combination; Eye Infections, Viral; Follow-Up Studies; Humans; Injections, Intravenous; Male; Middle Aged; Ophthalmoscopy; Pilot Projects; Retinitis; Zidovudine

Topics: Acyclovir; Antiviral Agents; DNA, Viral; Eye Infections, Viral; Herpes Simplex; Herpesvirus 2, Human; Humans; Retinal Necrosis Syndrome, Acute

To investigate differences in outcomes of acute retinal necrosis with confirmed viral polymerase chain reaction between viral types and highlight different treatment options.. The study evaluated 22 eyes in 18 patients of polymerase chain reaction-positive acute retinal necrosis at the University of Pittsburgh Medical Center from 2007 to 2018. Outcome measures included final visual acuity, treatment paradigms, and retinal detachment rate.. Eight eyes were polymerase chain reaction-positive for varicella zoster virus, two eyes for herpes simplex virus Type 1 (HSV-1), and 12 eyes for herpes simplex virus Type 2 (HSV-2). Final Snellen best-corrected visual acuity averaged 20/51 for varicella zoster virus, 20/25 for HSV-1, and 20/814 for HSV-2. Retinal detachment occurred in 2 (25%) of varicella zoster virus eyes and 8 (75%) of HSV-2 eyes. One eye with HSV-1 and three eyes with HSV-2 received cidofovir for treatment of refractory retinitis.. Acute retinal necrosis secondary to HSV-2 tended to have persistent active retinitis with a higher rate of retinal detachment despite similar treatment protocols, suggesting that in some cases combination intravenous acyclovir and adjuvant intravitreal foscarnet injections are not sufficient. Despite the risk of renal toxicity, intravenous cidofovir may be a consideration in select patients.

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Antiviral Agents; DNA, Viral; Eye Infections, Viral; Female; Follow-Up Studies; Foscarnet; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Middle Aged; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Treatment Outcome; Visual Acuity

To describe and to compare the clinical manifestation and laboratory test results of herpetic anterior uveitis (HAU) caused by Herpes simplex virus (HSV) and varicella-zoster virus (VZV).. A retrospective, observational study on patients diagnosed with HAU. Etiology, clinical features, ocular complications, and recurrences of the infection were evaluated as main clinical parameters. The aqueous Interleukin-8 (IL-8) level was also measured to assess the intraocular inflammation.. Thirty-two eyes (32 patients) were involved. Among all involved cases, 24 had VZV-AU and 8 had HSV-AU. Common clinical features of HAU included the presence of KPs (90.6%), distorted pupil (83.3%), Iris atrophy (71.9%) and corneal edema (50%). The intraocular fluid analysis showed higher viral load and IL-8 level in VZV-AU.. Compared with HSV-AU, the intraocular inflammation was more severe in VZV-AU. The intraocular fluid analysis was valuable for the etiological diagnosis and the evaluation of disease severity.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Aqueous Humor; Asian People; China; Drug Therapy, Combination; Eye Infections, Viral; Female; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpesviridae Infections; Herpesvirus 3, Human; Humans; Interleukin-8; Male; Middle Aged; Referral and Consultation; Retrospective Studies; Simplexvirus; Uveitis, Anterior; Valacyclovir; Viral Load; Visual Acuity; Young Adult

To describe the reactivation of Varicella-Zoster Virus Anterior Uveitis after YAG laser peripheral iridotomy.. A 69-year-old woman referred with unilateral, anterior uveitis associated with decreased corneal sensation and increased intraocular pressure 5 days after YAG laser peripheral iridotomy. The impression of herpetic anterior uveitis reactivation followed by YAG PI confirmed by polymerase chain reaction of aqueous humor by detecting varicella zoster virus. Treatment with oral acyclovir and topical corticosteroid and cycloplegic resulted control of both the intraocular inflammation and pressure.. YAG PI may be a risk factor for reactivation of herpetic anterior uveitis. Prophylaxis with acyclovir may be necessary after YAG PI to prevent reactivation of herpetic anterior uveitis.

Topics: Acyclovir; Aged; Antiviral Agents; Aqueous Humor; Eye Infections, Viral; Female; Herpesvirus 3, Human; Humans; Iris; Lasers, Solid-State; Latent Infection; Polymerase Chain Reaction; Uveitis, Anterior; Varicella Zoster Virus Infection

Other than well-known herpetic retinopathies like acute retinal necrosis, progressive outer retinal necrosis and cytomegalovirus retinitis, there are few reports on atypical forms of viral retinitis caused by herpes virus from around the world.. Presenting symptom was sudden onset of diminution of vision in all 6 cases. Mean duration of symptoms at presentation was 7.6 days. The mean age was 27.3 years (range 22-40 years). All were immunocompetent (4 females and 2 males), with unremarkable review of system. All had unilateral involvement. Presenting visual acuity ranged from CFCF to 6/60. Granulomatous anterior uveitis was present in 4 cases. All had focal retinitis with irregular margins, either juxtapapillary, macular or over one of the major vascular arcades. The diagnosis of focal viral retinitis was made solely based upon the clinical findings. All recovered after a course of oral acyclovir (one was given additional intravitreal acyclovir as well) and oral prednisolone, with final visual acuity of 6/6P to 6/9 in all except one.. In case of focal retinitis with irregular margin, viral etiology should be borne in mind. Clinical features are typical enough to help in diagnosing without PCR test.

Topics: Acyclovir; Adult; Antiviral Agents; Eye Infections, Viral; Female; Humans; Male; Retinal Necrosis Syndrome, Acute; Retinitis; Young Adult

To investigate the clinical characteristics and visual outcome of bilateral acute retinal necrosis.. The study included 30 patients (60 eyes) who were diagnosed with bilateral acute retinal necrosis. The medical records were reviewed.. Twenty-five patients developed the disease in the contralateral eye within 5 months and 5 patients at >2 years after the initial onset. At presentation, 14 of 21 eyes suffered from retinal necrosis of more than 180° in the initially affected eye, whereas 3 of 22 eyes suffered it in the later-affected eye. Retinal detachment occurred in 23 of the 27 initially affected eyes and in 5 of the 27 later-affected eyes. The mean logarithm of the minimum angle of resolution best-corrected visual acuity decreased from 2.0 ± 1.1 (Snellen equivalent counting fingers) to 2.2 ± 1.0 (Snellen equivalent counting fingers) in the initially affected eyes after a follow-up of 34.1 ± 48.2 months (P = 0.529), and improved from 0.5 ± 0.4 (Snellen equivalent 20/66) to 0.3 ± 0.4 (Snellen equivalent 20/40) in the later-affected eyes after a follow-up of 21.2 ± 23.3 months (P = 0.005).. Bilateral acute retinal necrosis usually occurs in the contralateral eye within a few months, but sometimes after several years. Inflammation and retinal necrosis are less severe in the later-affected eye, with less retinal detachment and a better visual outcome.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Eye Infections, Viral; Female; Ganciclovir; Herpes Simplex; Herpes Zoster Ophthalmicus; Herpesvirus 1, Human; Herpesvirus 2, Human; Herpesvirus 3, Human; Humans; Male; Middle Aged; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Visual Acuity; Vitrectomy; Young Adult

Herpes simplex virus (HSV) can affect the central nervous system causing meningitis, encephalitis and, rarely, acute retinal necrosis. We present a case of a 46-year-old man, previously healthy complaining of a 5-day persistent headache and sudden loss of vision of his left eye that progressed to the right. We started ceftriaxone, methylprednisolone and acyclovir for suspected encephalitis with vasculitis. HSV-1 was identified in vitreous and aqueous humour. Therapy with acyclovir was maintained and two intravitreous boluses of foscarnet were administered, without improvement. Usually being a benign infection, HSV can, in rare cases like this, have catastrophic effects in the optic tract.

Topics: Acyclovir; Administration, Intravenous; Antiviral Agents; Eye Infections, Viral; Herpesvirus 1, Human; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Vitreous Body

Topics: Acyclovir; Adult; Antiviral Agents; DNA, Viral; Eye Infections, Viral; Female; Follow-Up Studies; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Injections, Intravenous; Laser Therapy; Male; Middle Aged; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Treatment Outcome; Visual Acuity; Vitrectomy; Young Adult

To review the long-term outcomes of penetrating keratoplasty (PKP) for corneal complications of herpes zoster ophthalmicus (HZO).. We reviewed the medical records of 53 eyes of 53 patients who underwent PKP due to corneal complications of HZO at the Kellogg Eye Center.. The mean age of patients at the time of PKP was 68.0±16.4 years, with a follow-up of 4.0±3.8 years and quiescent period of 6.5±5.3 years from active HZO to PKP. Preoperatively, 25 (47.2%) eyes were completely anaesthetic, while 16 (30.2%) had deep corneal neovascularisation in four quadrants. Comorbid ocular disease, including cataract, glaucoma and macular disease, was present in 25 (47.2%) eyes. Twenty patients (37.8%) received acyclovir for the entire postoperative period. There were no recurrences of zoster keratitis in any eye. The most common complications were difficulty healing the ocular surface (12/53, 22.6%) and glaucoma (14/53, 26.4%). Thirty per cent of the eyes required one or more additional postoperative procedures, most commonly tarsorrhaphy (10/53, 18.9%) and amniotic membrane graft (6/53, 11.3%). At 1, 2-4 and ≥5 years, 94%, 82% and 70% grafts remained clear, respectively. Visual acuity improved at 1 year postoperatively (p<0.0001), but this improvement was not sustained. There was no significant benefit of long-term acyclovir on visual acuity (p=0.2132) or graft survival (p=0.241).. Even in eyes with significant preoperative risk factors, PKP for the corneal complications of HZO can achieve favourable tectonic and visual results. Although most grafts remained clear, long-term visual potential may be limited by comorbid ocular diseases. Prophylactic postoperative oral acyclovir did not improve outcomes.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Corneal Diseases; Eye Infections, Viral; Female; Follow-Up Studies; Graft Survival; Herpes Zoster Ophthalmicus; Humans; Keratoplasty, Penetrating; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Treatment Outcome; Visual Acuity

A 60-year-old man with a history of severe herpes simplex virus type 1 (HSV-1) encephalitis 2 years prior presented with acute onset of visual loss in the left eye. Dilated funduscopic examination showed retinitis and occlusive vasculitis with retinal necrosis. PCR of the vitreous fluid was positive for HSV-1, and he was diagnosed with acute retinal necrosis (ARN) due to HSV-1. The patient was treated with intravenous acyclovir and intravitreous foscarnet for 2 weeks, followed by high dose oral valacyclovir for 2 weeks. He was subsequently placed on planned life-long suppressive valacyclovir. His case demonstrates that acute visual loss concomitant with or subsequent to HSV-1 encephalitis warrants suspicion of ARN. Prompt therapy with effective antiviral medication is necessary to reduce the risk of sight-threatening complications. Chronic suppression with oral antiviral therapy after ARN is recommended to prevent involvement of the contralateral eye, though there is no consensus on the duration and dosage of antivirals.

Topics: Acute Disease; Acyclovir; Antiviral Agents; Diagnosis, Differential; Encephalitis, Herpes Simplex; Eye Infections, Viral; Foscarnet; Herpesvirus 1, Human; Humans; Intravitreal Injections; Male; Middle Aged; Ophthalmoscopes; Rare Diseases; Retinal Necrosis Syndrome, Acute; Treatment Outcome; Valacyclovir

To evaluate the performance of the xTAG liquid chip technology (xTAG-LCT) for etiological diagnosis of acute retinal necrosis (ARN).. Fifteen vitreous and 3 aqueous samples from 18 ARN patients were analyzed by xTAG-LCT and multiplex PCR (mPCR)/quantitative PCR (qPCR).. xTAG-LCT revealed positive results in 17 of the 18 samples: 10 for Varicella Zoster Virus (VZV) alone; 5 for VZV and Epstein-Barr virus (EBV); 1 for herpes simplex viruses type 1 (HSV-1) and EBV; 1 for VZV, HSV-1 and EBV. While mPCR revealed the same results as xTAG-LCT for VZV and HSV-1 in all samples, only 2 of the 7 samples positive for EBV on xTAG-LCT were confirmed by qPCR. None of the 28 control vitreous samples from 8 non-ARN patients and 10 pair of cadaveric eyes was positive for any of the tested viruses.. xTAG-LCT could be a useful alternative for etiological diagnosis of ARN.

Topics: Acyclovir; Adult; Antiviral Agents; Aqueous Humor; DNA, Viral; Eye Infections, Viral; Female; Ganciclovir; Herpesviridae; Herpesviridae Infections; Humans; Male; Middle Aged; Multiplex Polymerase Chain Reaction; Real-Time Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Valacyclovir; Vitreous Body; Young Adult

Chorioretinitis is an unusual form of varicella zoster virus (VZV)-associated uveitis, and no report has described VZV-associated chorioretinitis using serial optical coherence tomography (OCT) images obtained during the course of resolution.. A 61-year-old woman presented with acute, unilateral vision loss in her right eye. Her visual acuity was count fingers in the right eye and 16/20 in the left eye, and she exhibited skin vesicles on her right forehead. Slit lamp biomicroscopy, funduscopy, OCT, and intraocular fluid analysis were performed. The right eye exhibited multiple inflammatory lesions at the posterior pole, macular edema, and disc swelling on the fundus examination. OCT revealed predominant involvement of the choroid and the retinal pigment epithelium (RPE). Intraocular fluid analysis showed positivity for VZV. The patient was admitted and treated with intravenous acyclovir. Additional oral prednisolone was used to reduce the inflammatory reaction. After 2 weeks of treatment with acyclovir, the lesion resolved, with undulation of the RPE. Her final visual acuity was 20/20.. VZV-associated posterior uveitis may present as multifocal chorioretinitis. Intraocular fluid analysis is important to detect an infectious origin.

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Chorioretinitis; Combined Modality Therapy; Eye Infections, Viral; Female; Fluorescein Angiography; Glucocorticoids; Herpesvirus 3, Human; Humans; Middle Aged; Prednisolone; Tomography, Optical Coherence; Uveitis, Posterior; Varicella Zoster Virus Infection

To compare the visual outcomes of patients with acute retinal necrosis (ARN) treated initially with intravenous acyclovir vs oral valacyclovir therapy.. Retrospective, comparative, interventional case series.. Sixty-two patients (68 eyes) with ARN, treated at Moorfields Eye Hospital (United Kingdom) between 1992 and 2016, were identified through the hospital's electronic database. Exclusion criteria included insufficient patient records or follow-up (<150 days). Fifty-six patients had unilateral ARN, while 6 had bilateral ARN. Patients who received intravenous acyclovir on diagnosis (n = 33) were compared with patients treated with oral valacyclovir (n = 29) across outcomes including best-corrected visual acuity, retinal detachment, severe vision loss, and other complications. The impact of adjunctive intravitreal antiviral and prophylactic barrier laser treatment was also assessed.. Change in best-corrected visual acuity was not significantly different for eyes treated initially with intravenous therapy vs oral therapy over 5 years of follow-up data (P = .16). There was no difference in the rates of severe vision loss between the 2 groups (46% and 59%, respectively, P = .18), or of those eyes retaining good vision (28% vs 31%, respectively, P = .80). Retinal detachment occurred in 63% of cases and did not differ across treatment groups (62% vs 66%, respectively, P = .67). Barrier laser and intravitreal therapy had no effect on retinal detachment rate in either group.. Oral valacyclovir is clinically equivalent to intravenous therapy in the management of ARN. Oral valacyclovir as an outpatient therapy-with or without intravitreal foscarnet-can therefore be considered as an acceptable alternative to inpatient therapy required for intravenous treatment.

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Eye Infections, Viral; Female; Herpes Simplex; Herpesvirus 3, Human; Humans; Infusions, Intravenous; Male; Middle Aged; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Retrospective Studies; RNA, Viral; Simplexvirus; Valacyclovir; Varicella Zoster Virus Infection; Visual Acuity

Herpes zoster ophthalmicus (HZO) has variable initial manifestations, and acute orbital inflammation may be the first sign without apparent zoster rash. This case series is significant for presenting diverse clinical features and treatment options of HZO with acute orbital inflammation.. To report a case series of patients diagnosed as HZO with acute orbital inflammation including two cases with unique presentations.. Medical records of four patients of HZO with acute orbital inflammation were reviewed. Two men and two women with a median age of 57 years (range, 32 to 69 years) were diagnosed as having HZO with acute orbital inflammation. Initial presentations included two cases of zoster rash and two cases of orbital pain preceding vesicles. Clinical orbital findings included proptosis, ptosis, ophthalmoplegia, and decreased visual acuity. Orbital magnetic resonance image showed enlarged extraocular muscle with enhancement and optic nerve sheath enhancement in all four patients, and unilateral dacryoadenitis in one patient. All four patients were administered with systemic steroid, three patients received intravenous acyclovir, and one patient received oral acyclovir. Orbital signs improved in all patients over several months.. Herpes zoster ophthalmicus may initially present with orbital inflammatory signs, such as acute orbital myositis, perioptic neuritis, or dacryoadenitis, without zoster rash. Physicians should be aware of acute orbital inflammation as a presenting sign of HZO.

Topics: Acute Disease; Acyclovir; Adult; Aged; Antiviral Agents; Drug Combinations; Eye Infections, Viral; Female; Glucocorticoids; Herpes Zoster Ophthalmicus; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Orbital Myositis

To describe the clinical manifestations of herpes simplex keratitis (HSK) in a tertiary referral center in South Korea and to determine whether ascorbic acid treatment prevents recurrence of herpetic epithelial keratitis.. This retrospective cohort study included all consecutive patients with herpetic keratitis referred to our center from January 2010 to January 2015. Clinical features, ocular complications, and recurrences were recorded.. In total, 149 eyes of the 133 patients (72 male and 61 female) were followed for an average of 24.6 ± 13.2 months. Sixteen (12.0%) patients had bilateral HSK. The most frequent HSK subtype was epithelial keratitis (49.7%), which was followed by stromal keratitis (23.5%). Epithelial keratitis was the most likely subtype to recur. Complications occurred in 122 (81.9%) eyes. The most common complication was corneal opacity. Recurrences were observed in 48 (32.2%) eyes. The recurrence rates were lower in the prophylactic oral antiviral agent group (16 / 48 eyes, 33.3% vs. 49 / 101 eyes, 48.5%) and the ascorbic acid treatment group (13 / 48 eyes, 27.1% vs. 81 / 101 eyes, 70.3%) compared with the groups without medications. Univariate logistic regression analysis revealed that both factors significantly reduced the risk of recurrence (acyclovir: odds ratio, 0.25; 95% confidence intervals, 0.12 to 0.51; ascorbic acid: odds ratio, 0.51; 95% confidence intervals, 0.20 to 0.91).. This retrospective study described the clinical findings of HSK in a tertiary referral center in South Korea. Prophylactic oral antiviral agent treatment and oral ascorbic acid administration may lower the risk of recurrence.

Topics: Acyclovir; Administration, Oral; Adult; Aged; Aged, 80 and over; Antioxidants; Antiviral Agents; Ascorbic Acid; Drug Therapy, Combination; Eye Infections, Viral; Female; Follow-Up Studies; Humans; Incidence; Keratitis, Herpetic; Male; Middle Aged; Ophthalmoscopy; Recurrence; Republic of Korea; Retrospective Studies; Slit Lamp; Tertiary Care Centers; Time Factors; Treatment Outcome; Visual Acuity; Young Adult

Topics: Acyclovir; Administration, Ophthalmic; Antibodies, Viral; Antiviral Agents; Atrophy; Child; Enzyme-Linked Immunosorbent Assay; Eye Infections, Viral; Female; Glucocorticoids; Humans; Immunoglobulin G; Infusions, Intravenous; Intraocular Pressure; Mumps; Mumps virus; Prednisolone; Retinal Necrosis Syndrome, Acute; Retinal Pigment Epithelium; Tomography, Optical Coherence; Visual Acuity

To describe atypical varicella zoster virus (VZV) retinitis in a patient with Good syndrome.. A 63-year-old patient with Good syndrome presented with bilateral necrotizing retinitis starting from the posterior pole. He had a history of thymoma status post thymectomy 4 years previously, left-sided sinusitis, and recent pulmonary aspergillosis. Qualitative PCR was performed on aqueous fluid.. Immunological investigations revealed reduced levels of CD4. Good syndrome should be considered in a patient with opportunistic infections and history of thymoma in the absence of human immunodeficiency virus. Atypical retinitis can occur in patients with Good syndrome and quantitative PCR is important for accurate diagnosis.

Topics: Acyclovir; Agammaglobulinemia; Antiviral Agents; Aqueous Humor; CD4 Lymphocyte Count; DNA, Viral; Eye Infections, Viral; Fluorescein Angiography; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Middle Aged; Polymerase Chain Reaction; Retinitis; Thymoma; Thymus Neoplasms; Valacyclovir; Valine; Visual Acuity

To report a case of bilateral herpetic epithelial keratitis after bilateral intravitreal bevacizumab injections for the treatment of exudative age-related macular degeneration.. A 66-year-old man with diabetes and an extensive history of bilateral anti-vascular endothelial growth factor treatments for exudative age-related macular degeneration received an intravitreal bevacizumab injection in the right eye and triple therapy (bevacizumab, photodynamic therapy, and triamcinolone acetonide) in the left eye. After 4 days, he presented with pain, photophobia, tearing, and decreased vision in both eyes. Slit-lamp examination revealed bilateral dendritic epithelial lesions with terminal bulbs, and he was diagnosed with bilateral herpes simplex epithelial keratitis.. The patient was treated with ganciclovir ophthalmic ointment and oral acyclovir with resolution of signs and symptoms.. To our knowledge, this is the first documented account of bilateral herpetic epithelial keratitis after bilateral intravitreal bevacizumab injections.

Topics: Acyclovir; Aged; Angiogenesis Inhibitors; Antiviral Agents; Bevacizumab; Eye Infections, Viral; Ganciclovir; Humans; Intravitreal Injections; Keratitis, Herpetic; Male; Ointments; Ophthalmic Solutions; Postoperative Complications; Vascular Endothelial Growth Factor A; Wet Macular Degeneration

A necrotizing retinitis in children is a rare but vision-threatening ocular complication of chickenpox. We report a 10-year-old girl who developed chickenpox 1 month before presenting with panuveitis and necrotizing retinitis. After prompt antiviral treatment, her inflammatory signs were resolved. Early detection and treatment of varicella zoster-associated necrotizing retinitis after chickenpox can achieve good visual outcome.

Topics: Acyclovir; Antiviral Agents; Chickenpox; Child; Eye Infections, Viral; Female; Herpesvirus 3, Human; Hospitalization; Humans; Retina; Retinal Necrosis Syndrome, Acute

Topics: Acyclovir; Antiviral Agents; Cerebrospinal Fluid; DNA, Viral; Eye Infections, Viral; Female; Gestational Age; Herpes Simplex; Herpesvirus 2, Human; Humans; Infant, Extremely Low Birth Weight; Infant, Newborn; Infusions, Intravenous; Male; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Retinopathy of Prematurity

To report a case of occlusive retinal vasculopathy following varicella zoster infection in an immunocompetent adult.. Observational case report.. A patient with defective vision following chickenpox was evaluated with fluorescein angiography, spectral domain optical coherence tomography and fundus auto fluorescence.. Fundus showed multiple cotton wool spots and a well-demarcated zone of retinal ischemia in the posterior pole with normal optic disc without any evidence of anterior or posterior uveitis. Fluorescein angiography, spectral domain optical coherence tomography and fundus auto fluorescence findings revealed occlusive vasculopathy as the cause of defective vision.. We report a hitherto undescribed case of purely occlusive vasculopathy following varicella zoster infection without features of vasculitis or anterior and posterior uveitis in an immunocompetent individual.

Topics: Acyclovir; Administration, Oral; Adolescent; Antiviral Agents; Encephalitis, Varicella Zoster; Eye Infections, Viral; Female; Fluorescein Angiography; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Optical Imaging; Prednisolone; Retinal Necrosis Syndrome, Acute; Retinal Vessels; Tomography, Optical Coherence

Rituximab is a widely used biologic agent, which has shown favourable results in the treatment of vasculitis. But immunosuppressive treatment also bears the risk of severe complications.. A patient with rheumatoid arthritis, progressive scleromalacia, and acute retinal necrosis on therapy with rituximab is reported.. For the first time, a correlation between rituximab and acute retinal necrosis in a patient with progressive rheumatoid scleromalacia is shown.. Although rituximab is a promising biologic agent for the treatment of autoimmune diseases, it bears the risk of reactivation of viral infections, including the onset of acute retinal necrosis.

Topics: Acyclovir; Antiviral Agents; Aqueous Humor; Arthritis, Rheumatoid; Drug Therapy, Combination; Eye Infections, Viral; Female; Glucocorticoids; Herpes Simplex; Herpesvirus 1, Human; Humans; Immunosuppressive Agents; Middle Aged; Prednisone; Retinal Necrosis Syndrome, Acute; Rituximab; Scleritis; Virus Activation

Topics: Acyclovir; Antiviral Agents; Dacryocystitis; Drug Therapy, Combination; Eye Infections, Viral; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Methylprednisolone; Middle Aged; Orbital Myositis; Polymerase Chain Reaction

Topics: Acyclovir; Antiviral Agents; Aqueous Humor; Drug Therapy, Combination; Eye Infections, Viral; Female; Fluorescein Angiography; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Macula Lutea; Middle Aged; Necrosis; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Tomography, Optical Coherence

To study corneal reinnervation and sensation recovery in Herpes zoster ophthalmicus (HZO).. Two patients with HZO were studied over time with serial corneal esthesiometry and laser in vivo confocal microscopy (IVCM). A Boston keratoprosthesis type 1 was implanted, and the explanted corneal tissues were examined by immunofluorescence histochemistry for βIII-tubulin to stain for corneal nerves.. The initial central corneal IVCM performed in each patient showed a complete lack of the subbasal nerve plexus, which was in accordance with severe loss of sensation (0 of 6 cm) measured by esthesiometry. When IVCM was repeated 2 years later before undergoing surgery, case 1 showed a persistent lack of central subbasal nerves and sensation (0 of 6). In contrast, case 2 showed regeneration of the central subbasal nerves (4786 μm/mm) with partial recovery of corneal sensation (2.5 of 6 cm). Immunostaining of the explanted corneal button in case 1 showed no corneal nerves, whereas case 2 showed central and peripheral corneal nerves. Eight months after surgery, IVCM was again repeated in the donor tissue around the Boston keratoprosthesis in both patients to study innervation of the corneal transplant. Case 1 showed no nerves, whereas case 2 showed new nerves growing from the periphery into the corneal graft.. We demonstrate that regaining corneal innervation and corneal function are possible in patients with HZO as shown by corneal sensation, IVCM, and ex vivo immunostaining, indicating zoster neural damage is not always permanent and it may recover over an extended period of time.

Topics: Acyclovir; Aged; Aged, 80 and over; Antiviral Agents; Artificial Organs; Cornea; Eye Infections, Viral; Female; Fluorescent Antibody Technique, Indirect; Herpes Zoster Ophthalmicus; Humans; Microscopy, Confocal; Nerve Regeneration; Prosthesis Implantation; Recovery of Function; Sensation; Trigeminal Nerve; Tubulin; Valacyclovir; Valine

To describe 3 cases of herpes simplex virus (HSV) vesicular blepharitis that progressed to infectious epithelial keratitis despite treatment with oral acyclovir, but responded to topical antiviral therapy.. Retrospective review of a small case series.. One adult and 2 children presented with unilateral HSV vesicular blepharitis without evidence of corneal involvement. Each patient was placed on a therapeutic dose of oral acyclovir. While taking oral antiviral therapy, the patients developed HSV infectious epithelial keratitis, which was treated with trifluridine 1% solution 9 times daily in the adult and ganciclovir 0.15% ophthalmic gel 5 times daily in the 2 children. All 3 cases showed resolution of epithelial keratitis within 3 to 10 days after initiation of topical antiviral treatment while oral acyclovir was continued.. Oral antiviral therapy alone may not adequately prevent progression of infectious ocular HSV blepharoconjunctivitis. Topical antiviral therapy appeared to enable resolution of HSV epithelial keratitis that arose during oral acyclovir treatment.

Topics: Acyclovir; Administration, Oral; Administration, Topical; Adolescent; Adult; Antiviral Agents; Blepharitis; Child; Conjunctivitis, Viral; Disease Progression; Epithelium, Corneal; Eye Infections, Viral; Female; Ganciclovir; Humans; Keratitis, Herpetic; Male; Retrospective Studies; Trifluridine

Topics: Acyclovir; Antihypertensive Agents; Antiviral Agents; Aqueous Humor; Eye Infections, Viral; Herpes Simplex; Herpesvirus 1, Human; Humans; Intraocular Pressure; Lens Implantation, Intraocular; Male; Middle Aged; Ocular Hypertension; Phacoemulsification; Polymerase Chain Reaction; Uveitis; Virus Activation

Topics: Acyclovir; Administration, Oral; Adult; Antiviral Agents; Blepharitis; Eye Infections, Viral; Eyelid Diseases; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Skin Ulcer; Valacyclovir; Valine

Topics: Acyclovir; Administration, Oral; Adolescent; Antiviral Agents; CD56 Antigen; Exanthema; Eye Infections, Viral; Herpes Zoster Ophthalmicus; Humans; Immunologic Deficiency Syndromes; Killer Cells, Natural; Male

To report a rare case of concurrent acute retinal necrosis in a patient with iridocorneal endothelial syndrome (ICE).. Case report.. A 42-year-old woman showed acute diminution of vision in the right eye. Her fundus examination revealed features of acute retinal necrosis. She had also experienced gradual diminution of vision in her left eye for 5 years. The examination of her left eye revealed corneal edema with mild corectopia and increased intraocular pressure with abnormal endothelium on specular microscopy pointing to a diagnosis of ICE.. This is a rare case where concurrent acute retinal necrosis and ICE syndrome are present in the same patient, possibly pointing to a common viral etiology causing both entities.

Topics: Acyclovir; Adult; Antiviral Agents; Aqueous Humor; Eye Infections, Viral; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Iridocorneal Endothelial Syndrome; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Vitreous Body

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Child; Erythema Multiforme; Eye Infections, Viral; Eyelid Diseases; Herpes Simplex; Herpesvirus 1, Human; Humans; Male

Aciclovir (ACV), valaciclovir (VACV) and famciclovir (FCV) are used for systemic infections caused by herpes virus. In Japan, only topical ACV is permitted for use against herpetic keratitis. We investigated the effectiveness of topical ACV, oral VACV and oral FCV on mouse epithelial herpetic keratitis.. C57/BL76 mice were inoculated with HSV-1 McKrae strain in the cornea. Once infection was confirmed 4 days after inoculation, topical ACV, oral VACV and FCV were started and administered for 5 days. Control groups were given either topical or oral saline. On days 2, 4, 6 and 10 after medication started, tears, eyeballs, and trigeminal ganglia were examined using viral culture and real-time PCR.. Viral culture of tears detected no HSV in the topical ACV group on day 4 after administration start; with similar results for the oral VACV group on day 4; and the oral FCV group on day 6. Real-time PCR of the eyeballs showed significant decrease of HSV DNA copy number in the topical ACV group on days 4 and 6 compared to the topical saline group. Real-time PCR of the trigeminal ganglia showed significant decrease of HSV DNA copy number in the oral VACV group on days 4 and 6, and in the oral FCV group on day 6 compared to the oral saline group.. We suggest that 5-day administration of topical ACV, oral VACV and oral FCV are effective for mouse epithelial herpetic keratitis and sufficiently decrease HSV amounts in the ocular surface and eyeballs.

Topics: 2-Aminopurine; Acyclovir; Administration, Oral; Administration, Topical; Animals; Antiviral Agents; Disease Models, Animal; DNA Copy Number Variations; DNA, Viral; Epithelium, Corneal; Eye Infections, Viral; Famciclovir; Female; Herpesvirus 1, Human; Keratitis, Herpetic; Mice; Mice, Inbred C57BL; Real-Time Polymerase Chain Reaction; Tears; Trigeminal Nerve; Valacyclovir; Valine

Acute retinal necrosis (ARN) should be in the differential diagnosis of a neonate who presents with vitritis. This report includes three cases of neonatal ARN at the Bascom Palmer Eye Institute from 2004 to 2009. Medical treatment with acyclovir helped reduce sequelae of herpes simplex virus (HSV) 2 infection. Patients with ARN are at risk for retinal detachment and blindness. Although mothers are screened during pregnancy, they are at risk of reactivation or primary contraction of HSV. A neonate presenting with vitritis should raise suspicion of ARN.

Topics: Acyclovir; Antibodies, Viral; Antiviral Agents; Aqueous Humor; DNA, Viral; Eye Infections, Viral; Female; Gestational Age; Herpes Simplex; Herpesvirus 2, Human; Humans; Infant; Male; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Aqueous Humor; DNA, Viral; Drug Therapy, Combination; Eye Infections, Viral; Female; Fluorescein Angiography; Ganciclovir; Herpes Simplex; Herpesvirus 1, Human; Humans; Infusions, Intravenous; Intravitreal Injections; Macular Edema; Middle Aged; Polymerase Chain Reaction; Prednisolone; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Tomography, Optical Coherence

To analyze the clinical presentation, characteristics, treatment, recurrences, and final outcomes and complications of herpes simplex virus (HSV) disease of the anterior segment in patients aged 17 years or younger.. This is an observational and retrospective study with review of the medical records of all the children diagnosed with herpes simplex infection of the anterior segment at an ophthalmologic referral center, from 2002 to 2012. The diagnosis was made on the basis of the history and examination of patients and in specific cases by viral culture and the polymerase chain reaction. Main outcome measurements included final visual acuity, bilateral disease, and recurrence. Recurrent disease was analyzed with Kaplan-Meier curves.. A total of 103 patients were included with a median age at presentation of 9 years. Of them, 6 had bilateral and simultaneous disease. The median follow-up time was 18 months (range, 18 days-12 years). The most common clinical manifestations were epithelial dendritic keratitis in 42 eyes (38.5%) and interstitial keratitis in 39 eyes (35.7%), with 15 patients presenting multiple forms of HSV disease. The median final visual acuity in the group of patients was 20/40. Recurrent disease was evident in 42 (38.5%) of the eyes, with a median recurrence time of 15 months (95% confidence interval, 8.1-26.2 months).. In this study, epithelial dendritic and interstitial keratitis were the most frequent forms of disease in the pediatric population with HSV of the anterior segment. A high rate of recurrent disease was present.

Topics: Acyclovir; Administration, Oral; Administration, Topical; Adolescent; Anterior Eye Segment; Antiviral Agents; Child; Child, Preschool; DNA, Viral; Eye Infections, Viral; Female; Herpesvirus 1, Human; Humans; Infant; Keratitis, Dendritic; Keratitis, Herpetic; Male; Polymerase Chain Reaction; Retrospective Studies

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Chorioretinitis; Drug Combinations; Exudates and Transudates; Eye Infections, Viral; Fluorescein Angiography; Foscarnet; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Intravitreal Injections; Male; Middle Aged; Ophthalmic Solutions; Parasympatholytics; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Tropanes; Valacyclovir; Valine

The use of in vivo confocal microscopy has been valuable in detecting and managing corneal pathology. This case study documents endotheliitis using in vivo confocal microscopy where apparent resolution of endothelial edema on clinical examination resulted in the discovery of subclinical findings with confocal scanning. The purpose of this case study was to discuss a rare corneal pathology and the clinical value of confocal scanning.. A 30-year-old Asian Indian woman presented with unilateral endotheliitis and trabeculitis of presumed varicella zoster virus etiology. She was treated successfully with oral antiviral and topical corticosteroid therapy. Subclinical endotheliitis was detected using in vivo confocal microscopy, prompting the continuation of prophylactic, low-dose, topical corticosteroid therapy and topical hyperosmotics.. Further research is warranted to better understand the role of confocal microscopy in endotheliitis therapeutic management, endothelial cell count and morphology, and keratic precipitate characterization. To date, prophylactic oral antivirals and/or topical corticosteroids may play a role in immune suppression of the herpes virus, although prospective, randomized, controlled clinical trials have not focused specifically on endotheliitis cases.

Topics: Acyclovir; Adult; Anti-Inflammatory Agents; Antiviral Agents; Corneal Edema; Drug Therapy, Combination; Endothelium, Corneal; Eye Infections, Viral; Female; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Keratitis; Microscopy, Confocal; Prednisolone; Prospective Studies

Topics: Acyclovir; Antiviral Agents; Aqueous Humor; DNA, Viral; Drug Therapy, Combination; Eye Infections, Viral; Gene Dosage; Glucocorticoids; Humans; Keratitis, Herpetic; Male; Middle Aged; Prednisolone; Real-Time Polymerase Chain Reaction; Simplexvirus; Uveitis, Anterior; Valacyclovir; Valine

To report a case of Acute Retinal Necrosis (ARN)-developed nephrotoxicity during intravenous acyclovir treatment and toxic hepatitis during oral valacyclovir treatment.. Interventional case report.. Retrospective chart review.. A 45-year-old male with ARN treated with intravenous acyclovir developed nephrotoxicity. After switching to oral valacyclovir, toxic hepatitis developed. Both renal and liver function tests returned to normal levels after drug cessation. Although rare, clinicians should be aware of the potential nephrotoxic and hepatotoxic side effects of antiviral therapy during ARN treatment.

Topics: Acyclovir; Antiviral Agents; DNA, Viral; Eye Infections, Viral; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Middle Aged; Polymerase Chain Reaction; Renal Insufficiency; Retinal Necrosis Syndrome, Acute; Valacyclovir; Valine

Acute retinal necrosis (ARN) is an infectious retinitis primarily caused by the herpesviruses. Although the Epstein-Barr virus (EBV) has been implicated as a cause of ARN, to our knowledge, there has been no histopathologic documentation. We report the clinical history and histopathologic confirmation that EBV can cause ARN.. Clinical course and histopathology of a patient diagnosed with ARN caused by infection with EBV confirmed by molecular pathology.. Epstein-Barr virus is a recognized cause of intraocular inflammation and has been implicated as a possible cause of ARN. However, to our knowledge, tissue demonstration of EBV in a patient with ARN has not previously been reported. We identified the organism in the necrotic retina of a patient receiving immunosuppression because of idiopathic pulmonary fibrosis.

Topics: Acyclovir; Antibodies, Viral; Antigens, Viral; Antiviral Agents; Capsid Proteins; DNA, Viral; Epstein-Barr Virus Infections; Epstein-Barr Virus Nuclear Antigens; Eye Enucleation; Eye Infections, Viral; Female; Glucocorticoids; Herpesvirus 4, Human; Humans; Immunoglobulin G; Middle Aged; Retinal Necrosis Syndrome, Acute; Valacyclovir; Valine; Vitreous Body

Topics: Acyclovir; Aged; Antibodies, Viral; Antiviral Agents; Coloring Agents; Conjunctival Diseases; Eye Infections, Viral; Female; Herpes Simplex; Humans; Immunoglobulin G; Lissamine Green Dyes; Simplexvirus; Ulcer; Valacyclovir; Valine

To compare the outcomes of combination systemic and intravitreal antiviral therapy vs systemic antiviral therapy alone for treating acute retinal necrosis syndrome (ARN). We hypothesize that combination therapy might result in superior visual acuity (VA) and retinal detachment (RD) outcomes vs traditional systemic antiviral therapy alone.. A retrospective, interventional, comparative single-center study of patients with ARN. We reviewed demographic data, herpesvirus diagnoses, polymerase chain reaction (PCR) results, VA, RD, and the use of systemic and intravitreal antiviral therapy. Outcome measures included VA improvement by 2 or more lines, severe visual loss, VA ≤20/200, and RD.. We studied 29 eyes of 24 patients, treated from 1987 through 2009. Mean age was 42.6 years and mean follow-up was 44.0 months. Twelve patients (14 eyes) were treated with combined systemic and intravitreal antiviral therapy and 12 patients (15 eyes) with systemic therapy alone. Kaplan-Meier survival analysis revealed that patients receiving combination intravitreal and systemic antiviral therapy were more likely to have VA improved by 2 lines or greater (P=.006). Patients receiving combination therapy also showed a decreased incidence of progression to severe visual loss (0.13/patient-years [PY]) compared to patients receiving systemic therapy alone (0.54/PY, P=.02) and had decreased incidence of RD (0.29/PY vs 0.74/PY, P=.03).. Combination oral and intravitreal antiviral therapy may improve visual and functional outcomes in patients with ARN. Clinicians should consider prompt administration of combination systemic and intravitreal antiviral therapy as first-line treatment for patients with clinical features of ARN.

Topics: 2-Aminopurine; Acyclovir; Administration, Oral; Adult; Antiviral Agents; Aqueous Humor; Cytomegalovirus; DNA, Viral; Drug Therapy, Combination; Eye Infections, Viral; Famciclovir; Female; Humans; Injections, Intravenous; Intravitreal Injections; Male; Middle Aged; Polymerase Chain Reaction; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Simplexvirus; Treatment Outcome; Valacyclovir; Valine; Visual Acuity; Vitreous Body

To examine the effectiveness of prolonged oral acyclovir treatment in patients with acute retinal necrosis (ARN).. Fifty-five ARN patients (62 eyes) who had been treated with short-term or long-term oral acyclovir were identified in this retrospective study: one group treated with prolonged oral acyclovir (≥14 weeks) and the other group treated with a shorter duration of oral acyclovir (<14 weeks). The authors examined whether the prolonged treatment reduced the involvement of the contralateral eye. They also evaluated prognostic factors for visual outcome.. Prolonged oral acyclovir treatment reduced the involvement of the contralateral eye (p = .036). The visual outcome was influenced by the timing of treatment initiation after symptom onset (p = .030), the age of the patient (p = .027), the area of retinal disease (p = .026), and the retinal detachment (p = .002).. Prolonged oral acyclovir treatment had a significant role in preventing the involvement of the contralateral eye.

Topics: Acyclovir; Aged; Aged, 80 and over; Antiviral Agents; Eye Infections, Viral; Female; Herpesviridae Infections; Humans; Male; Middle Aged; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Treatment Outcome; Visual Acuity

To describe the clinical characteristics, treatment, and outcomes of herpes simplex virus (HSV) infections of the cornea and adnexae to raise awareness and to improve management of this important eye disease in children.. Retrospective case series.. Fifty-three patients (57 eyes) 16 years of age or younger with HSV keratitis (HSK), HSV blepharoconjunctivitis (HBC), or both in an academic cornea practice.. The following data were collected: age at disease onset, putative trigger factors, coexisting systemic diseases, duration of symptoms and diagnoses given before presentation, visual acuity, slit-lamp examination findings, corneal sensation, dose and duration of medications used, drug side effects, and disease recurrence.. Presence of residual corneal scarring, visual acuity at the last visit, changes in corneal sensation, recurrence rate, and manifestations of HSK were assessed in patients receiving long-term prophylactic systemic acyclovir.. The median age at onset was 5 years. Mean follow-up was 3.6 years. Eighteen eyes had HBC only; 4 patients in this group had bilateral disease. Of 39 eyes with keratitis, 74% had stromal disease. Thirty percent of HSK cases were misdiagnosed before presentation. Seventy-nine percent of patients with keratitis had corneal scarring and 26% had vision of 20/40 or worse at the last visit. Eighty percent of patients had recurrent disease. Six of 16 patients (37%) receiving long-term oral acyclovir had recurrent HSV, at least one case of which followed a growth spurt that caused the baseline dosage of acyclovir to become subtherapeutic.. In a large series, pediatric HSK had a high rate of misdiagnosis, stromal involvement, recurrence, and vision loss. Oral acyclovir is effective, but the dosage must be adjusted as the child grows.

Topics: 2-Aminopurine; Acyclovir; Administration, Topical; Adolescent; Age of Onset; Anterior Eye Segment; Antiviral Agents; Blepharitis; Child; Child, Preschool; Conjunctivitis, Viral; Eye Infections, Viral; Famciclovir; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Infant; Keratitis, Herpetic; Male; Ointments; Retrospective Studies; Trifluridine; Valacyclovir; Valine; Vidarabine

To report a case of progressive outer retinal necrosis (PORN) presenting as a cherry red spot.. Case report.. A 53-year-old woman with recently diagnosed HIV and varicella-zoster virus (VZV) aseptic meningitis developed rapid sequential vision loss in both eyes over 2 months. Her exam showed a "cherry red spot" in both maculae with peripheral atrophy and pigmentary changes, consistent with PORN. Due to her late presentation and the rapid progression of her condition, she quickly developed end-stage vision loss in both eyes.. PORN should be considered within the differential diagnosis of a "cherry red spot." Immune-deficient patients with a history of herpetic infection who present with visual loss warrant prompt ophthalmological evaluation.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; AIDS-Related Opportunistic Infections; Antiretroviral Therapy, Highly Active; Antiviral Agents; Blindness; Disease Progression; Eye Infections, Viral; Female; Herpes Zoster Ophthalmicus; Humans; Middle Aged; Mucolipidoses; Retinal Necrosis Syndrome, Acute; Valacyclovir; Valine

Topics: Acyclovir; Anti-Infective Agents; Antiviral Agents; DNA, Viral; Drug Therapy, Combination; Epstein-Barr Virus Infections; Eye Infections, Viral; Fluorescein Angiography; Herpesvirus 4, Human; Humans; Infectious Mononucleosis; Male; Middle Aged; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Trimethoprim, Sulfamethoxazole Drug Combination; Valacyclovir; Valine; Vitreous Body

To report a case of herpes simplex virus-induced herpetic necrotizing retinitis after placement of a flucinolone acetonide (Retisert) intravitreal implant.. Interventional case report.. Retrospective chart review.. A 22-year-old male with idiopathic unilateral panuveitis since 2002 that was intolerant of systemic immunosuppressive therapy received a flucinolone acetonide implant 6 years later. Intraocular inflammation was completely quiescent until 1 year following the implant, when he developed retinitis. To the authors' knowledge, this is the first reported case of polymerase chain reaction-proven herpetic necrotizing retinitis following implantation of a Retisert device.. Although rare, herpetic necrotizing retinitis can occur in the setting of local ocular immunosuppression with the Retisert intravitreal implant. This potential infection should be considered in the face of recurrent uveitis following Retisert implantation.

Topics: Acyclovir; Antiviral Agents; Azathioprine; Cataract; Drug Implants; Eye Infections, Viral; Herpes Simplex; Herpesvirus 2, Human; Humans; Immunosuppressive Agents; Male; Mycophenolic Acid; Panuveitis; Pregnadienetriols; Retinal Necrosis Syndrome, Acute; Treatment Outcome; Valacyclovir; Valine; Visual Acuity; Young Adult

Topics: Acyclovir; Aged; Aged, 80 and over; DNA, Viral; Drug Therapy, Combination; Eye Infections, Viral; Female; Ganciclovir; Herpes Zoster Ophthalmicus; Herpes Zoster Vaccine; Herpesvirus 3, Human; Humans; Male; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Vaccination; Valacyclovir; Valine; Visual Acuity

To report a case of unilateral varicella zoster virus (VZV) retinal vasculitis aspect in an immunocompetent child without systemic infection. Clinically, no signs of retinal necrosis or frosted branch vasculitis were present. This is an observational case report. Quantitative PCR was performed on the aqueous humor (AH) using primers specific for herpes virus (cytomegalovirus, Epstein-Barr virus, herpes simplex virus 1-2, and VZV). The patient was treated with intravenous acyclovir, intravitreous ganciclovir, and oral valacyclovir. A positive quantitative PCR result was found for VZV DNA (1.72 x 10(6) viral copies/ml) in the AH. After 6 months, PCR of the AH was negative. Herpes viruses are involved in the pathogenesis of isolated retinal vasculitis. This case demonstrates that quantitative PCR is useful to detect viral DNA in AH and to monitor the viral activity and the therapeutic response.

Topics: Acyclovir; Antiviral Agents; Aqueous Humor; Child; DNA, Viral; Drug Administration Routes; Eye Infections, Viral; Female; Ganciclovir; Herpesvirus 3, Human; Humans; Photophobia; Polymerase Chain Reaction; Retinal Vasculitis; Treatment Outcome; Valacyclovir; Valine; Vision, Low

To study the effects of intravitreal foscarnet and the clinical differences between varicella zoster virus (VZV) and herpes simplex virus (HSV) induced acute retinal necrosis (ARN).. Retrospective comparative case series.. Eighty-one eyes of 74 patients.. A retrospective case note analysis was performed in 2 tertiary referral centers.. Presenting and final visual acuity, and progression to retinal detachment.. Thirty-three eyes had HSV-ARN and 48 had VZV-ARN. The average age for HSV-ARN was 34 years and 51 for VZV-ARN (P<0.001). Visual acuity on presentation was similar (P = 0.48), but a larger proportion had better vision (> or =20/60) in the HSV-ARN group (52%) than the VZV-ARN group (35%). A greater proportion of eyes with poor vision (< or =20/200) was found at the 12-month follow-up in the VZV-ARN group (60%) compared with the HSV-ARN group (35%). A greater degree of visual loss in the VZV-ARN group (0.4 logarithm of the minimum angle of resolution [logMAR]) compared with the HSV-ARN group (0.04 logMAR) was detected (P = 0.016). Retinal detachment was 2.5-fold more common in VZV-ARN (62%) compared with HSV-ARN (24%). When comparing eyes treated with (n = 56) and without (n = 25) intravitreal foscarnet, there was a 40% lower rate in retinal detachment (53.6% vs 75.0%) for VZV-ARN (P = 0.23). The numbers with HSV-ARN were too small for analysis.. The results support the difference of outcome in HSV-ARN and VZV-ARN. Therefore, viral identification serves as a key to predicting outcome in these patients. Intravitreal foscarnet seems to be a useful adjunct for the treatment of ARN in that it reduced rate of retinal detachment.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Child; Eye Infections, Viral; Female; Foscarnet; Herpes Simplex; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Infusions, Intravenous; Male; Middle Aged; Polymerase Chain Reaction; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Simplexvirus; Visual Acuity; Vitreous Body; Young Adult

Topics: Acyclovir; Adult; Antiviral Agents; Eye Infections, Viral; Herpesviridae; Herpesviridae Infections; Humans; Male; Retinal Necrosis Syndrome, Acute

Topics: Acyclovir; Antiviral Agents; Combined Modality Therapy; Drug Therapy, Combination; Epstein-Barr Virus Infections; Eye Infections, Viral; Glucocorticoids; Herpes Simplex; Herpes Zoster Ophthalmicus; Humans; Prednisolone; Retinal Necrosis Syndrome, Acute; Treatment Outcome; Visual Acuity; Vitrectomy; Vitreous Body

To describe 3 cases of an acute zonal occult outer retinopathy-like illness responsive to valacyclovir hydrochloride.. Retrospective, interventional case series.. Three patients were treated with valacyclovir and monitored by clinical examination, Goldmann visual field testing, and electroretinography.. Patients with an acute zonal occult outer retinopathy-like illness presented following progressive vision loss. This course was immediately reversed by treatment with oral valacyclovir, and visual acuity and visual field improved significantly at 1 week and 1 month. Patients remained stable without treatment during a follow-up period ranging from 1 to 3 years.. Some conditions with features of acute zonal occult outer retinopathy may be attributable to a subacute herpetic viral infection that is responsive to oral antiviral medication.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Antiviral Agents; Electroretinography; Eye Infections, Viral; Female; Herpesviridae Infections; Humans; Male; Retinal Diseases; Retrospective Studies; Scotoma; Tomography, Optical Coherence; Valacyclovir; Valine; Visual Field Tests; Visual Fields

To determine the viral diagnosis and the outcome of eyes with acute retinal necrosis (ARN) treated with intravenous acyclovir and oral prednisolone alone or combined with early vitrectomy and intravitreal acyclovir lavage.. Nonrandomized, retrospective, interventional, comparative, consecutive series.. A cohort of 27 human immunodeficiency virus-negative patients with ARN comprising 24 unilateral and 3 bilateral cases.. Vitreous biopsy for viral diagnosis. Twenty eyes were treated with intravenous acyclovir in combination with oral prednisolone (group A). Ten eyes were treated additionally with early vitrectomy, intravitreal acyclovir lavage, laser demarcation of necrotic retinal areas when feasible-with or without scleral buckling, and gas or silicone oil tamponade (group B). Vitrectomy was performed in all cases of secondary rhegmatogenous retinal detachment (RD).. Results of vitreous biopsy, rate of RD, rate of phthisis bulbi, and course of best-corrected visual acuity (BCVA).. Varicella zoster virus (VZV) was detected in 26 eyes, followed by herpes simplex virus (5 eyes), and Epstein-Barr virus (2 eyes, in conjunction with VZV). An RD developed in more eyes in group A (18 of 20 eyes) than in group B (4 of 10 eyes; P = 0.007). In 2 of 20 eyes in group A and in 0 of 10 eyes in group B, phthisis bulbi developed without a significant difference between groups A and B. Mean BCVA (logarithm of the minimum angle of resolution) at first visit was 1.09 (standard deviation [SD], 0.83), and mean final BCVA was 1.46 (SD, 0.88) without significant difference between groups A and B.. Varicella zoster virus is the leading cause of ARN. Visual prognosis is guarded. Early vitrectomy with intravitreal acyclovir lavage was associated with a lower incidence of secondary RD; however, it did not improve mean final visual acuity.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Combined Modality Therapy; Drug Therapy, Combination; Epstein-Barr Virus Infections; Eye Infections, Viral; Female; Glucocorticoids; Herpes Simplex; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Prednisolone; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Treatment Outcome; Visual Acuity; Vitrectomy; Vitreous Body; Young Adult

To characterize in detail persistent and recalcitrant infectious scleritis resulting from herpes simplex virus (HSV).. Retrospective and interventional clinical and immunopathologic case series.. Nine patients with chronic scleral redness, edema, and pain refractory to conventional therapy underwent a scleroconjunctival biopsy for routine histopathologic evaluation and definitive immunodiagnosis for the presence of HSV. Immunofluorescent probing for HSV was performed on the patient specimens. Negative controls for HSV included elimination of anti-HSV and anti-varicella zoster virus antibody in the probing process and the use of normal human conjunctiva and sclera as substrates. Response to therapy with acyclovir was monitored and recorded.. The average age of the affected patients was 50.2 years, and the average duration of symptoms before tissue diagnosis of herpetic scleritis was 3.2 years (median, 4 years). Three histopathologic patterns were discovered: granulomatous inflammation (2 cases), plasma cell-rich pyogenic granuloma-like pattern (1 case), and reactive fibroinflammatory pattern (6 cases). Herpes antigen was demonstrated uniformly by immunofluorescence in a perivascular distribution and less commonly in the interstitium. Varicella zoster virus was not detected, and all controls for nonspecific antibody reagent binding to tissue showed negative results. Acyclovir caused a dramatic improvement in the chronic or recurrent ocular inflammation in all instances, with an average duration of improvement of inflammation of 15.3 months.. Unrecognized HSV infection can cause longstanding scleritis. Histopathologic features of HSV scleritis are varied and nonspecific; immunofluorescent demonstration of HSV protein can make a definitive diagnosis. Prolonged administration of acyclovir is required for effective therapy.

Topics: Acyclovir; Adult; Aged; Antigens, Viral; Antiviral Agents; Chronic Disease; Eye Infections, Viral; Female; Fluorescent Antibody Technique, Indirect; Herpes Simplex; Humans; Male; Middle Aged; Retrospective Studies; Scleritis; Simplexvirus; Time Factors

Topics: Acyclovir; Antiviral Agents; DNA, Viral; Drug Therapy, Combination; Eye Infections, Viral; Foscarnet; Humans; Laser Coagulation; Polymerase Chain Reaction; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Treatment Outcome; Valacyclovir; Valine; Vitrectomy; Vitreous Body

To report ocular manifestations associated with chikungunya.. Retrospective, nonrandomized, observational case series.. Nine chikungunya patients with ocular involvement.. All patients with chikungunya infection presenting with ocular complaints from September 2006 to October 2006 were included in the study. The infection was confirmed by demonstration of chikungunya immunoglobulin M antibody in sera of all patients. All patients underwent an ophthalmic examination including fundus photography, fundus fluorescein angiography, confocal microscopy of keratic precipitates, and optical coherence tomography. Positive ocular changes were recorded and tabulated.. Characteristics, frequency, and locations of ocular lesions found in the participants.. There were 9 patients with ocular lesions; 1 had nodular episcleritis, 5 presented with acute iridocyclitis, and 3 had retinitis. Four to 12 weeks before the development of ocular manifestations, all of these patients had fever. Although there were no specific changes of iridocyclitis that were diagnostic of the fever, the retinal changes were consistent with viral retinitis. All patients recovered from the infection with relatively good vision.. It appears that iridocyclitis and retinitis are the most common ocular manifestations associated with chikungunya, with a typically benign clinical course. Less frequent ocular lesions include episcleritis. All the patients responded well to the treatment with preservation of good vision. To the best of our knowledge, similar ocular manifestations associated with chikungunya infection have not been reported. In the differential diagnosis of iridocyclitis and retinitis with features suggestive of a viral infection, the entity of chikungunya-associated ocular changes should be considered in the regions affected by the epidemic.

Topics: Acyclovir; Adult; Aged; Alphavirus Infections; Antibodies, Viral; Antiviral Agents; Chikungunya virus; Diclofenac; Drug Therapy, Combination; Eye Infections, Viral; Female; Fluorescein Angiography; Humans; Immunoglobulin M; Iridocyclitis; Male; Microscopy, Confocal; Middle Aged; Prednisolone; Retinitis; Retrospective Studies; Scleritis; Tomography, Optical Coherence; Visual Acuity

To investigate clinical manifestations and response to antiviral therapy of 8 patients with cytomegalovirus (CMV)-induced corneal endotheliitis who were diagnosed and treated at 2 university hospitals in Japan.. Retrospective, consecutive, multicenter case series.. Eight eyes of 8 patients diagnosed with active CMV corneal endotheliitis at Kyoto Prefectural University of Medicine and Ehime University School of Medicine. The diagnosis was made based on the detection by polymerase chain reaction assay of CMV, but not herpes simplex virus (HSV) and varicella zoster virus (VZV) DNA, in the aqueous humor from the affected eye.. Retrospective review of the clinical manifestations and responses to antiviral treatment.. Patient profiles, including duration of corneal endotheliitis, systemic disease, intraocular pressure, and clinical manifestation of anterior and posterior segments. The clinical response to systemic and topical antiviral treatment was evaluated by slit-lamp examination. Corneal endothelial density was examined by specular microscopy.. The average observation period after CMV detection was 10.4 months (range, 2-24 months). None of the patients had systemic immunodeficiency. Corneal manifestations included linear keratic precipitates associated with multiple coin-shaped lesions and local corneal stromal edema. Of the 8 patients, 4 had undergone penetrating corneal transplantation. Systemic ganciclovir therapy was used in 7 patients, and in 1 patient, valacyclovir was administered, with the corneal endotheliitis responding quickly to the early administration of galovir. At the final examination, 6 eyes had a clear cornea, but 2 eyes had bullous keratopathy.. Besides HSV and VZV, CMV must be considered as an etiologic agent in patients with corneal endotheliitis. Cytomegalovirus corneal endotheliitis may be a newly identified clinical entity of reactivated CMV in the anterior chamber of individuals free of accompanying systemic symptoms.

Topics: Acyclovir; Administration, Topical; Aged; Aged, 80 and over; Antiviral Agents; Aqueous Humor; Cell Count; Cytomegalovirus; Cytomegalovirus Infections; DNA, Viral; Endothelium, Corneal; Eye Infections, Viral; Female; Ganciclovir; Humans; Keratitis; Male; Middle Aged; Polymerase Chain Reaction; Retrospective Studies; Valacyclovir; Valine

Topics: Acyclovir; Aged; AIDS-Related Opportunistic Infections; Drug Resistance, Viral; Drug Therapy, Combination; Eye Infections, Viral; Ganciclovir; Humans; Immunocompromised Host; Male; Prednisone; Retinal Necrosis Syndrome, Acute; Valganciclovir

Acute retinal necrosis (ARN) is a distinct ocular viral syndrome traditionally treated with intravenous acyclovir followed by oral acyclovir. We investigated the use of the oral antiviral medications valacyclovir and famciclovir as the sole treatment for patients with newly diagnosed ARN syndrome.. Retrospective, uncontrolled, interventional case series.. Eight consecutive patients with newly diagnosed ARN treated solely with oral antiviral medications.. All patients received famciclovir or valacyclovir without antecedent intravenous therapy. One patient with bilateral ARN treated with famciclovir received a single intravitreal injection of foscarnet in the more severely involved eye.. Clinically and photographically documented complete resolution of retinitis and best-corrected visual acuity on final follow-up.. Active retinitis resolved completely in 10/10 (100%) affected eyes. Initial response to treatment was seen as early as 4 days (in 5 eyes), with a median time to complete resolution of 14 days. At the last examination, visual acuity was improved (> or = 2 Snellen lines) in 6 (60%) eyes, stable in 2 (20%) eyes, and worse in 2 (20%) eyes. Over a mean follow-up of 36 weeks (range, 7-72 weeks), 3 eyes developed rhegmatogenous retinal detachment that was successfully repaired with 1 vitrectomy surgery. No patient with initially unilateral involvement developed disease in the contralateral eye.. In this pilot study, the use of the oral drugs valacyclovir and famciclovir resulted in complete regression of herpetic necrotizing retinitis. Additional studies are necessary to evaluate the role of these antiherpetic medications in the treatment of the ARN syndrome.

Topics: 2-Aminopurine; Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Eye Infections, Viral; Famciclovir; Female; Follow-Up Studies; Herpes Simplex; Herpes Zoster Ophthalmicus; Humans; Male; Pilot Projects; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Valacyclovir; Valine; Visual Acuity

To determine the viral diagnosis and factors affecting the visual outcome of eyes with acute retinal necrosis.. Nonrandomized, retrospective, interventional, noncomparative series.. A cohort of 22 human immunodeficiency virus-negative patients with acute retinal necrosis (ARN). There were 17 unilateral and 5 bilateral cases.. Diagnostic vitreous biopsy for polymerase chain reaction (PCR) viral DNA analysis, prophylactic barrier laser posterior to necrotic retina to try to prevent rhegmatogenous retinal detachment (RD), intravenous acyclovir in combination with oral, and vitrectomy for RD repair.. Results of PCR viral DNA analysis, relationship between prophylactic barrier argon laser photocoagulation and occurrence of RD, and visual acuities at presentation and follow-up.. Varicella-zoster virus (VZV) was detected in 66.7% (12/18) of eyes (66.7% of patients [10/15]) with vitreous biopsy and herpes simplex virus (HSV) in 22.2% (4/18) of eyes (20% of patients [3/15]). Epstein-Barr virus (EBV) was detected in 16.7% (3/18) of eyes (20% of patients [3/15]), and all the EBV-positive eyes were also positive for VZV. Polymerase chain reaction results were identical in both eyes of bilateral cases (5 patients) and were negative in 11.1% (2/18) of eyes (13.3% of patients [2/15]) biopsied. Systemic corticosteroid treatment given before ARN diagnosis did not appear to increase the risk of developing RD (P = 0.69). Rhegmatogenous RD occurred in 35.3% (6/17) of eyes given prophylactic argon laser treatment and in 80% (8/10) of eyes that could not be lasered prohylactically. Of RDs, 96.3% (13/14) occurred after the third week and up to 5 months from onset of symptoms. The VA after surgical repair of RD improved relative to the presentation acuity in 33.3% (4/12) of eyes.. Varicella-zoster virus is the leading cause of ARN. We recommend the management of ARN to include prompt diagnosis; prophylactic argon laser retinopexy, preferably within the first 2 weeks to reduce risk of RD; systemic acyclovir; and corticosteroids to control the severe inflammation associated with ARN. Despite the guarded visual prognosis, RD repair may result in improved visual outcomes.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Combined Modality Therapy; DNA, Viral; Epstein-Barr Virus Infections; Eye Infections, Viral; Female; Glucocorticoids; Herpes Simplex; Herpes Zoster Ophthalmicus; Herpesvirus 1, Human; Herpesvirus 2, Human; Herpesvirus 3, Human; Herpesvirus 4, Human; Humans; Laser Coagulation; Male; Middle Aged; Polymerase Chain Reaction; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Treatment Outcome; Vitrectomy; Vitreous Body

A 50-year-old woman developed rapidly progressive acute renal failure on the first day after the administration of intravenous acyclovir for acute left retinal necrosis. Intravenous acyclovir was stopped and replaced with intravitreal injections of ganciclovir sodium (2 mg/0.05 mL) and foscarnet (1.2 mg/0.05 mL) 3 times per week for 4 weeks. Acyclovir-induced renal impairment can be reversed if recognised early and treated with careful, timely body fluid replacement. The necrotising retinitis responded well to intravitreal antiviral agents. No complications were seen at the 6 months' follow-up. Constant vigilance is essential for avoiding acute renal failure when treating ophthalmic conditions with intravenous acyclovir. Systematic monitoring of renal function, urine output, and characteristic symptoms like loin pain is warranted.

Topics: Acute Kidney Injury; Acyclovir; Antiviral Agents; Eye Infections, Viral; Female; Herpesvirus 3, Human; Humans; Middle Aged; Retinal Necrosis Syndrome, Acute

Topics: 2-Aminopurine; Acyclovir; Administration, Oral; Antiviral Agents; Eye Infections, Viral; Famciclovir; Herpes Simplex; Herpes Zoster Ophthalmicus; Humans; Retinal Necrosis Syndrome, Acute; Valacyclovir; Valine; Visual Acuity

Topics: Acyclovir; Antiviral Agents; Eye Infections, Viral; Ganciclovir; Herpes Zoster; Humans; Retinal Necrosis Syndrome, Acute; Valacyclovir; Valganciclovir; Valine

Topics: Acyclovir; Administration, Oral; Anemia, Refractory, with Excess of Blasts; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Cytarabine; DNA, Viral; Eye Infections, Viral; Granulocyte Colony-Stimulating Factor; Herpesvirus 3, Human; Humans; Male; Middle Aged; Retinitis; Stem Cell Transplantation; Transplantation, Homologous; Valacyclovir; Valine; Vidarabine

To report the case of an immunocompetent child with herpes simplex virus-2 (HSV-2) acute retinal necrosis (ARN) syndrome, who was considered to have an idiopathic unilateral panuveitis sensitive to steroid treatment.. Polymerase chain reaction for detection of viral DNA was applied to ocular fluids and in situ hybridization was performed on a retinal sample. HSV serology was performed using the ELISA and Western blot techniques, and an in-house indirect immunofluorescence technique.. In addition to the atypical clinical presentation, the serological assays for HSV were negative using ELISA at the time of diagnosis of ARN and 1 year after. HSV2 infection was confirmed by using polymerase chain reaction of aqueous humor specimen and in situ hybridization of a retinal biopsy. Retrospective analysis with the Western blot technique detected low titers of anti-HSV antibodies, when the sera were concentrated 5-fold.. Herpes virus infections must be investigated in children with posterior or panuveitis. PCR analysis is a reliable technique for diagnosis. This case emphasizes that clinical presentation can be atypical and that a negative viral serology does not exclude an acute or a past herpetic infection.

Topics: Acyclovir; Antibodies, Viral; Antiviral Agents; Aqueous Humor; Child, Preschool; Chronic Disease; DNA, Viral; Enzyme-Linked Immunosorbent Assay; Eye Infections, Viral; Herpes Simplex; Herpesvirus 2, Human; Humans; In Situ Hybridization; Male; Panuveitis; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Valacyclovir; Valine

To report cytomegalovirus (CMV) DNA in aqueous humor from a patient with unilateral corneal endotheliitis.. Case report.. A 51-year-old man presented with unilateral corneal endotheliitis with linear keratic precipitates and coin-shaped lesions. Tear and aqueous humor samples were subjected to polymerase chain reaction to look for DNA from herpes simplex virus (HSV), varicella zoster virus (VZV), and CMV.. Aqueous humor from the diseased eye contained DNA from CMV but not HSV or VZV. Its specificity was confirmed by Southern blot tests. Intravenous ganciclovir treatment resulted in the localization of his corneal edema and the reduction in keratic precipitates. There was severe destruction of corneal endothelial cells. CMV DNA was not detected in tears or control samples.. In this healthy man with corneal endotheliitis, we detected CMV DNA in aqueous humor from the affected eye, but not HSV or VZV. This suggests that CMV may cause corneal endotheliitis in patients without immunodeficiency.

Topics: Acyclovir; Antiviral Agents; Aqueous Humor; Blotting, Southern; Cytomegalovirus; Cytomegalovirus Infections; DNA, Viral; Drug Therapy, Combination; Endothelium, Corneal; Eye Infections, Viral; Ganciclovir; Humans; Keratitis; Male; Middle Aged; Polymerase Chain Reaction

Derivatives of the herpes simplex thymidine kinase inhibitor HBPG [2-phenylamino-9-(4-hydroxybutyl)-6-oxopurine] have been synthesized and tested for inhibitory activity against recombinant enzymes (TK) from herpes simplex types 1 and 2 (HSV-1, HSV-2). The compounds inhibited phosphorylation of [3H]thymidine by both enzymes, but potencies differed quantitatively from those of HBPG and were generally greater for HSV-2 than HSV-1 TKs. Changes in inhibitory potency were generally consistent with the inhibitor/substrate binding site structure based on published X-ray structures of HSV-1 TK. In particular, several 9-(4-aminobutyl) analogues with bulky tertiary amino substituents were among the most potent inhibitors. Variable substrate assays showed that the most potent compound, 2-phenylamino-9-[4-(1-decahydroquinolyl)butyl]-6-oxopurine, was a competitive inhibitor, with Ki values of 0.03 and 0.005 microM against HSV-1 and HSV-2 TKs, respectively. The parent compound HBPG was uniquely active in viral infection models in mice, both against ocular HSV-2 reactivation and against HSV-1 and HSV-2 encephalitis. In assays lacking [3H]thymidine, HBPG was found to be an efficient substrate for the enzymes. The ability of the TKs to phosphorylate HBPG may relate to its antiherpetic activity in vivo.

Topics: Animals; Antiviral Agents; Cloning, Molecular; Encephalitis, Herpes Simplex; Eye Infections, Viral; Guanine; Herpesvirus 1, Human; Herpesvirus 2, Human; Mice; Phosphorylation; Purinones; Recombinant Proteins; Structure-Activity Relationship; Thymidine Kinase; Virus Activation

Noncompliance with assigned therapies is ubiquitous in randomized clinical trials. Treatment effects may be corrected for noncompliance using Robins' structural nested models, but few examples have been published. The Herpetic Eye Disease Study randomized 703 ocular herpes patients to 365 days of acyclovir or placebo between 1992 and 1996, and achieved over 90% compliance in both arms. The hazard of recurrence in the acyclovir arm was 0.55 times the hazard in the placebo arm using an intent-to-treat approach (95% confidence interval [CI]: 0.41, 0.75). Assuming a structural nested model with a Weibull distribution, the hazard of recurrence under constant exposure to acyclovir was 0.41 times that of the non-exposed (test-based 95% CI: 0.28, 0.72), or 34% larger than the intent-to-treat estimate. Notwithstanding excellent compliance, intent-to-treat estimates may notably undervalue the causal effect of a treatment.

Topics: Acyclovir; Adolescent; Adult; Child; Eye Infections, Viral; Female; Herpesviridae Infections; Humans; Male; Middle Aged; Models, Statistical; Patient Compliance; Placebos; Randomized Controlled Trials as Topic; Recurrence; Risk Factors; Sensitivity and Specificity

Topics: Acyclovir; Adult; Antiviral Agents; DNA, Viral; Eye Infections, Viral; Herpesvirus 3, Human; Humans; Laser Coagulation; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Recurrence; Retinal Necrosis Syndrome, Acute; Stem Cell Transplantation; Transplantation, Homologous; Valacyclovir; Valine

We report the case of a 53-year-old woman with uveitis in her right eye. She suffered from meningoencephalitis two years before. In the ophthalmic examination she showed no light perception, mild anterior uveitis and severe vitritis, which prevented from visualizing the retina. We suspected herpetic acute retinal necrosis (ARN), so therapy with intravenous acyclovir was started and a diagnostic vitrectomy was performed. Peripheral retinal necrosis and pallor of the optic disc were observed. PCR of the vitreous was positive for herpes simplex virus type I.. This is probably a case of brain-to-eye virus transmission. According to this, the ARN would support the etiologic suspicion of the previous encephalitis.

Topics: Acyclovir; Antiviral Agents; Blindness; Diagnosis, Differential; DNA, Viral; Encephalitis, Herpes Simplex; Eye Infections, Viral; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Magnetic Resonance Imaging; Middle Aged; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Vitreous Body

To evaluate the clinical outcome and medical management in a series of patients diagnosed with acute retinal necrosis.. Between 1993 and 2000, 22 patients suffering from acute retinal necrosis were referred to our department. We retrospectively reviewed the clinical course, delay between diagnosis and first clinical manifestation, biological profiles, treatment and complications.. All patients had vitreous inflammation; retinitis was seen upon examination in 82% of the cases. Nevertheless, for six patients (27% of the cases), failure to recognize the diagnosis led to delay (mean, 5.5 days) between the first ophthalmological examination and antiviral therapy. Nineteen patients underwent laboratory evaluation, and virological diagnosis was made in 16 of them: varicella zoster virus was found in 11 cases, herpes simplex type 1 in three cases, and herpes simplex type 2 and cytomegalovirus in one case each. Nine patients were treated with a combination of aciclovir and foscarnet and 13 with aciclovir alone. Among the 16 patients who received aciclovir, one did not respond to therapy after 2 days and was cured only after foscarnet was added. Recurrence occurred at the end of treatment in only one patient. Retinal detachment complicated the course for 11 patients and was always associated with proliferative vitreoretinopathy. Among those, seven of the ten patients who accepted surgery were successfully treated. Eleven out of 22 patients had a final visual acuity up to 20/200 and two up to 20/40.. In our series, acyclovir alone was sufficient to cure the majority of cases. Even with antiviral therapy, the prognosis of acute retinal necrosis remains poor. Retinal detachment is the main complication.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Cytomegalovirus Retinitis; Drug Therapy, Combination; Eye Infections, Viral; Female; Foscarnet; Herpes Simplex; Herpes Zoster Ophthalmicus; Humans; Infant; Male; Middle Aged; Prognosis; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Visual Acuity; Vitreoretinopathy, Proliferative

The purpose of this case series was to present an overview of the nature and frequency of ocular complications in the Department of Defense (DoD) Smallpox Vaccination Program.. Retrospective, noncomparative case series.. The authors retrospectively evaluated data collected on individuals with an ophthalmologic complaint after receiving smallpox vaccination or after contact with a recently immunized individual. The vaccinee and contact cases occurred secondary to inoculations given between December 13, 2002 and May 28, 2003 as part of the DoD Smallpox Vaccination Program.. Data were collected primarily from reports to military headquarters or to the Vaccine Adverse Event Reporting System and individual medical records.. The incidence, types, and timing of ocular complications were evaluated. Diagnostic and treatment considerations also were reviewed.. Between December 13, 2002 and May 28, 2003, 450,293 smallpox vaccinations were given. We identified 16 confirmed or probable cases of ocular vaccinia, with an incidence of 3.6 per 100,000 inoculations. Of these cases, 12 (75%) were seen in the vaccinees, and 4 (25%) in close contacts. Of the 12 self-inoculation cases, 7 (58.3%) were seen in individuals receiving the vaccine for the first time (primary vaccination), and 3 (25.0%) were seen in individuals previously vaccinated (revaccination); the vaccination status in 2 cases was unknown. Clinical manifestations included lid pustules, blepharitis, periorbital cellulitis, conjunctivitis, conjunctival ulcers, conjunctival membranes, limbal pustules, corneal infiltrates, and iritis, with onset of symptoms 3 to 24 days after inoculation or contact. Five of 9 tested cases were culture or polymerase chain reaction positive for vaccinia. Treatment for most cases was topical trifluridine 1% (Viroptic; King Pharmaceuticals, Inc., Bristol, TN). Vaccinia immune globulin was used in 1 case. In all patients, recovery occurred without significant visual sequelae.. When compared with historical data on the ocular complications of smallpox vaccination, the incidence of ocular complications during the DoD Smallpox Vaccination program has been low. In addition, the severity of disease seems to be less than during other vaccination periods. These findings perhaps are the result of improved screening of vaccinees, prevaccination counseling, postvaccination wound care, and the suggested efficacy of trifluridine in the treatment of ocular vaccinia.

Topics: Acyclovir; Adolescent; Adult; Adverse Drug Reaction Reporting Systems; Antiviral Agents; Conjunctival Diseases; Corneal Diseases; Eye Infections, Viral; Eyelid Diseases; Female; Humans; Immunization Programs; Incidence; Infection Control; Male; Middle Aged; Military Medicine; Military Personnel; Retrospective Studies; Smallpox Vaccine; Trifluridine; United States; Vaccination; Vaccinia

Topics: Acyclovir; Adult; Antiviral Agents; Dacryocystitis; Eye Infections, Viral; Herpes Simplex; Herpesvirus 1, Human; Humans; Immunocompromised Host; Lacrimal Apparatus; Male

Topics: Acyclovir; Administration, Topical; Antiviral Agents; Eye Infections, Viral; Female; Humans; Keratitis, Herpetic; Middle Aged; Phototherapy; Virus Activation

To report a side effect of epidural corticosteroid injections for back pain.. Case series.. Review of clinical charts and photographs.. Private retina practice.. Two patients developed acute retinal necrosis syndrome following epidural corticosteroid injections for back pain. Referral was delayed in one patient. One patient developed bilateral secondary rhegmatogenous retinal detachment, and both developed secondary macular pucker.. Acute retinal necrosis can follow epidural corticosteroid injections. Patients should be warned about this possibility and advised to report should photopsias, photosensitivity, blurred vision, or new floaters develop after treatment. Orthopedists should be aware of the complication and promptly refer patients with symptoms for dilated fundus examination by an ophthalmologist.

Topics: Acyclovir; Aged; Antibodies, Viral; Antiviral Agents; Eye Infections, Viral; Female; Glucocorticoids; Herpes Simplex; Herpes Zoster Ophthalmicus; Herpesvirus 1, Human; Herpesvirus 2, Human; Herpesvirus 3, Human; Humans; Immunoglobulin G; Injections, Epidural; Low Back Pain; Male; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Virus Activation

Aqueous humor analysis can be performed in severe atypical forms of posterior uveitis unresponsive to conventional treatment to exclude a viral infection.. Noncomparative interventional case series.. Thirty-seven immunocompetent patients seen with corticosteroid-resistant forms of posterior uveitis underwent extensive evaluation, including anterior chamber paracentesis, to rule out a nonnecrotizing viral retinopathy.. Aqueous fluid samples were prospectively obtained. Polymerase chain reaction (PCR) and serologic evaluation of intraocular antibody production against herpesviruses were performed by molecular techniques and enzyme-linked immunosorbent assay.. Polymerase chain reaction and local antibody production for herpes simplex virus types 1 and 2, varicella-zoster virus, cytomegalovirus, and Epstein-Barr virus were determined on aqueous fluid samples.. Viral infection was confirmed in 5 cases (13.5%). Clinical presentation included birdshot-like retinochoroidopathy, occlusive bilateral vasculitis, and cystoid macular edema. An antiviral regimen was initiated in all cases. Inflammation was stabilized, and steroid dosage could be significantly reduced.. Identification of a viral agent during severe posterior uveitis can dramatically change therapeutic management.

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Antibodies, Viral; Antiviral Agents; Aqueous Humor; Diagnosis, Differential; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; Eye Infections, Viral; Female; Fluorescein Angiography; Glucocorticoids; Herpesviridae; Herpesviridae Infections; Humans; Male; Middle Aged; Polymerase Chain Reaction; Prednisone; Retinal Diseases; Uveitis, Posterior; Valacyclovir; Valine

It is usual to consider chicken pox as a benign infectious disease with a few anterior segment ocular complications like conjunctivitis, keratitis, episcleritis, scleritis, iridocyclitis, and glaucoma. The retinal manifestations are necrotising retinitis, vitritis, neuroretinitis, and retinal detachments. We report a case of neuroretinitis following chicken pox in a 23-year-old male. The complication was resolved by treatment with oral acyclovir in combination with systemic steroids. This report highlights the necessity for fundus examination in cases of chickenpox exhibiting visual symptoms.

Topics: Acyclovir; Administration, Oral; Adult; Antiviral Agents; Chickenpox; Drug Therapy, Combination; Eye Infections, Viral; Glucocorticoids; Humans; Male; Prednisolone; Retinitis

Topics: Acyclovir; Antiviral Agents; Eye Infections, Viral; Glaucoma; Herpes Simplex; Herpesvirus 1, Human; Humans; Intraocular Pressure; Iritis; Male; Middle Aged; Pigment Epithelium of Eye; Uveitis, Anterior

Topics: Acyclovir; Administration, Oral; Adult; Aged; Antiviral Agents; Eye Infections, Viral; Herpes Simplex; Herpes Zoster Ophthalmicus; Humans; Male; Retinal Necrosis Syndrome, Acute; Valacyclovir; Valine

A case of acute severe loss of vision due to perivasculitis typical of frosted retinal branch angiitis due to Herpes simplex virus in an otherwise healthy young Omani lady is presented.

Topics: Acyclovir; Administration, Oral; Adrenal Cortex Hormones; Adult; Antibodies, Viral; Antiviral Agents; Drug Therapy, Combination; Eye Infections, Viral; Female; Fluorescein Angiography; Follow-Up Studies; Fundus Oculi; Herpes Simplex; Humans; Immunocompetence; Immunoglobulin M; Infusions, Intravenous; Retinal Vasculitis; Simplexvirus

To report the diagnosis, management, and outcome of acute retinal necrosis syndrome in children.. Case series of three consecutive children aged 11 years and younger who were diagnosed with acute retinal necrosis. In addition to full ocular and systemic examinations, the children underwent vitreous biopsy (Patients 1 and 2) or aqueous tap (Patient 3) for polymerase chain reaction analysis.. All patients had unilateral retinitis that was associated with preexisting chorioretinal scars, and two patients (Patients 1 and 3) had concurrent extraocular central nervous system abnormalities. Intraocular herpes simplex virus was detected in all three children: Type 1 in Patient 1 and Type 2 in Patients 2 and 3. In addition, all three children had a history of extraocular herpes simplex virus infection.. Retinitis associated with preexisting chorioretinal scars and detectable intraocular herpes simplex virus on polymerase chain reaction was common to all three children with acute retinal necrosis.

Topics: Acyclovir; Antiviral Agents; Child; DNA, Viral; Eye Infections, Viral; Female; Herpes Simplex; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Male; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute

To describe a case of severe dry eye syndrome in a child.. Observational case report. The authors describe a 10-year-old male with severe dry eyes who was profoundly disabled by pain and photophobia despite aggressive conventional therapy. Lacrimal gland histology was consistent with the primary Sjögren syndrome, and serologic and immunohistologic evidence supported the hypothesis of Epstein-Barr virus causality.. Treatment with systemic acyclovir and cyclosporin A resulted in dramatic and rapid reversal of the profound sicca syndrome and enabled the patient to resume his normal activities.. Epstein-Barr virus dacryoadenitis should be considered in the differential diagnosis of keratoconjunctivitis sicca in children. Epstein-Barr virus can cause keratoconjunctivitis sicca, which can be treated successfully with acyclovir therapy in addition to suppression of the inflammatory response.

Topics: Acyclovir; Antiviral Agents; Child; Cyclosporine; Dacryocystitis; Drug Therapy, Combination; Epstein-Barr Virus Infections; Eye Infections, Viral; Glucocorticoids; Humans; Immunosuppressive Agents; Keratoconjunctivitis Sicca; Male; Nasolacrimal Duct; Prednisone

Topics: Acyclovir; Antiviral Agents; Drug Therapy, Combination; Encephalitis, Viral; Eye Infections, Viral; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Middle Aged; Prednisolone; Prodrugs; Retinal Necrosis Syndrome, Acute; Tropanes; Vitreous Body

To present a unique case in which orbital inflammation, proptosis, and optic neuritis were the initial symptoms of acute retinal necrosis (ARN). The clinical presentation of ARN, as well as the currently recommended diagnostic procedures and guidelines for medical treatment of ARN, are summarized.. Interventional case report.. Polymerase chain reaction (PCR) techniques were made on the vitreous for cytomegalovirus, Epstein-Barr virus, herpes simplex virus (HSV), varicella zoster virus, and toxoplasmosis. A full laboratory evaluation was made together with HLA-typing and serologic tests measuring convalescent titers for HSV and other micro-organisms. Magnetic resonance imaging scan, computed tomography (CT) scan, and fluorescein angiographic examination were performed. The patient was treated with acyclovir and oral prednisone.. The patient was evaluated for initial and final visual acuity and for degree of proptosis, periocular edema, and vitreitis.. The first symptoms and signs of ARN were eye pain, headache, proptosis, and a swollen optic nerve on CT scan. Other than increased C-reactive protein, all blood samples were normal. PCR was positive for HSV-type I in two separate vitreous biopsies. The patient had the strongly ARN-related specificity HLA-DQ7.. This is the first report of HSV-induced ARN presenting with inflammatory orbitopathy and optic neuritis. Polymerase chain reaction for HSV-1 was positive more than 4 weeks after debut of symptoms, which is a new finding. The combination of severe vitreitis and retinal whitening, with or without proptosis, should alert the clinician to the possibility of herpes infection and treatment with intravenous acyclovir started promptly.

Topics: Acyclovir; Adult; Antibodies, Viral; DNA, Viral; Exophthalmos; Eye Infections, Viral; Female; Fluorescein Angiography; Herpes Simplex; Herpesvirus 1, Human; Humans; Magnetic Resonance Imaging; Optic Neuritis; Orbital Pseudotumor; Polymerase Chain Reaction; Prednisolone; Retinal Necrosis Syndrome, Acute; Tomography, X-Ray Computed; Vitreous Body

To report the use of intravitreal antiviral injections as adjunctive therapy in the management of three immunocompetent patients with necrotizing herpetic retinopathy.. Case series.. Three patients with necrotizing herpetic retinopathy received intravitreal antiviral injections for treatment of progressive retinitis, despite standard intravenous acyclovir therapy. The retinitis resolved and visual acuity improved after a minimum of 6 months of follow-up in each case.. Intravitreal antiviral injections may be a safe and efficacious adjunctive therapy in the management of patients with necrotizing herpetic retinopathy.

Topics: Acyclovir; Adult; Antiviral Agents; Chemotherapy, Adjuvant; Drug Therapy, Combination; Eye Infections, Viral; Female; Ganciclovir; Herpes Simplex; Humans; Immunocompetence; Injections; Male; Middle Aged; Retinal Necrosis Syndrome, Acute; Visual Acuity; Vitreous Body

Varicella zoster virus (VZV) infection involving the posterior segment of the eye after fludarabine treatment has not previously been described. Two patients, who had completed fludarabine treatment 3 and 18 months previously, presented with visual loss that had been preceded by a recent history of cutaneous zoster. The use of the polymerase chain reaction (PCR) for VZV DNA from ocular specimens allowed rapid confirmation of clinical diagnosis and treatment with a good outcome in one patient. With the increasing use of fludarabine and other purine analogues, an awareness of such complications is important because of their potentially sight-threatening consequences.

Topics: Acyclovir; Aged; Aged, 80 and over; Antiviral Agents; DNA, Viral; Eye Infections, Viral; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunosuppressive Agents; Lymphoma, Follicular; Male; Middle Aged; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Vidarabine; Waldenstrom Macroglobulinemia

A 17-year-old youth presented with bilateral follicular conjunctivitis and nummular subepithelial corneal infiltrates. Failure of this to settle in an outpatient setting led to corneal scraping with microscopy and culturing for bacteria, fungi, Herpes simplex, adenovirus and Acanthamoeba as an inpatient. Polymerase chain reaction analysis of corneal cells was positive for adenovirus, and culture on live Escherichia coli-coated agar plates was positive for Acanthamoeba by phase contrast microscopy on day two. We conclude that Acanthomoeba infection can complicate adenoviral keratoconjunctivitis. This observation is in keeping with previously reported modes of infection by Acanthamoeba, whereby any epithelial breach seems to allow inoculation of the eye by this opportunistic organism.

Topics: Acanthamoeba; Acanthamoeba Keratitis; Acyclovir; Adenovirus Infections, Human; Adenoviruses, Human; Adolescent; Animals; Biguanides; Cyclopentolate; Drug Therapy, Combination; Eye Infections, Viral; Humans; Keratoconjunctivitis; Male; Prednisolone

Topics: Acyclovir; Antibodies, Viral; CD4 Lymphocyte Count; Disease Progression; Eye Infections, Viral; Female; Fluorescein Angiography; Fundus Oculi; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; HIV Antibodies; HIV Seronegativity; Humans; Immunocompromised Host; Middle Aged; Prednisolone; Purpura, Thrombocytopenic, Idiopathic; Retinal Necrosis Syndrome, Acute

To report treatment of a patient with acute retinal necrosis during pregnancy.. A 24-year-old woman in her twenty-third week of gestation was diagnosed with acute retinal necrosis. A combination of acyclovir and interferon therapy was started at 25 weeks. Pars plana vitrectomy was performed during the 26th week of gestation.. The necrotizing retina became gliotic within 3 weeks of surgery. The patient's visual acuity improved to LE, 20/40. A healthy baby was delivered at 39 weeks of gestation.. Combination therapy of acyclovir and interferon followed by surgery partially restored the patient's vision without affecting fetal development.

Topics: Acyclovir; Adult; Antiviral Agents; DNA, Viral; Drug Therapy, Combination; Eye Infections, Viral; Female; Gestational Age; Herpes Simplex; Herpesvirus 1, Human; Humans; Interferon-beta; Polymerase Chain Reaction; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Pregnancy Trimester, Second; Retinal Necrosis Syndrome, Acute; Visual Acuity; Vitrectomy; Vitreous Body

Acute retinal necrosis (ARN) syndrome is associated with members of the herpes virus family, but the mechanisms of infection remain unclear. The purpose of this study is to report a unique case of acute retinal necrosis syndrome associated with herpetic encephalitis in order to elucidate possible factors involved in herpetic central nervous system disease.. Case report.. A 64-year-old woman who developed acute herpes simplex virus encephalitis associated with bilateral acute retinal necrosis syndrome after craniotomy for resection of a suprasellar craniopharyngioma is presented. The results of lumbar puncture, magnetic resonance imaging, and ophthalmologic examination are consistent with herpetic infection. The origin of acute retinal necrosis syndrome and the association of acute retinal necrosis syndrome with encephalitis are reviewed.. After craniotomy, we hypothesize reactivation of previously latent herpes simplex virus in the area of the inferior frontal lobe and optic chiasm. Reactivated virus may have migrated to the retina by axonal transport, through the optic nerves, to produce the acute retinal necrosis syndrome.

Topics: Acyclovir; Axonal Transport; Cerebrospinal Fluid; Craniopharyngioma; Craniotomy; Encephalitis, Viral; Eye Infections, Viral; Female; Herpes Simplex; Herpesvirus 2, Human; Humans; Magnetic Resonance Imaging; Middle Aged; Optic Nerve; Pituitary Neoplasms; Retinal Necrosis Syndrome, Acute; Spinal Puncture; Virus Activation; Virus Latency

To report a case of acute viral disease accompanied by bilateral optic neuritis with substantial paraclinical evidence that human immunodeficiency virus was the causative agent.. Clinical and paraclinical examination. Magnetic resonance imaging.. Virus and antibody titers as well as reverse lymphocytosis were consistent with acute infection by the human immunodeficiency virus-1.. Human immunodeficiency virus infection should be considered in the differential diagnosis of acute optic neuritis.

Topics: Acute Disease; Acyclovir; Adult; Diagnosis, Differential; Enzyme-Linked Immunosorbent Assay; Eye Infections, Viral; Female; HIV Antibodies; HIV Infections; HIV-1; Humans; Magnetic Resonance Imaging; Optic Nerve; Optic Neuritis; Polymerase Chain Reaction; Prednisolone; RNA, Viral

Varicella zoster virus retinitis (VZVR) in patients with AIDS, also called progressive outer retinal necrosis (PORN), is a necrotising viral retinitis which has resulted in blindness in most patients. The purposes of this study were to investigate the clinical course and visual outcome, and to determine if the choice of a systemic antiviral therapy affected the final visual outcome in patients with VZVR and AIDS.. A review of the clinical records of 20 patients with VZVR from six centres was performed. Analysis of the clinical characteristics at presentation was performed. Kruskall-Wallis non-parametric one way analysis of variance (KWAOV) of the final visual acuities of patients treated with acyclovir, ganciclovir, foscarnet, or a combination of foscarnet and ganciclovir was carried out.. Median follow up was 6 months (range 1.3-26 months). On presentation, 14 of 20 patients (70%) had bilateral disease, and 75% (15 of 20 patients) had previous or concurrent extraocular manifestations of VZV infection. Median initial and final visual acuities were 20/40 and hand movements, respectively. Of 39 eyes involved, 19 eyes (49%) were no light perception at last follow up; 27 eyes (69%) developed rhegmatogenous retinal detachments. Patients treated with combination ganciclovir and foscarnet therapy or ganciclovir alone had significantly better final visual acuity than those treated with either acyclovir or foscarnet (KWAOV: p = 0.0051).. This study represents the second largest series, the longest follow up, and the first analysis of visual outcomes based on medical therapy for AIDS patients with VZVR. Aggressive medical treatment with appropriate systemic antivirals may improve long term visual outcome in patients with VZVR. Acyclovir appears to be relatively ineffective in treating this disease.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; AIDS-Related Opportunistic Infections; Analysis of Variance; Antiviral Agents; Eye Infections, Viral; Female; Foscarnet; Ganciclovir; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Retinal Detachment; Retinitis; Retrospective Studies; Treatment Outcome; Visual Acuity

To describe a case of retinal perivasculitis in an immunocompetent patient with systemic herpes simplex infection.. Polymerase chain reaction amplifications were performed for aqueous and blood samples using primers specific for the following members of the herpesvirus family: cytomegalovirus, Epstein-Barr virus, herpes simplex virus (types 1 and 2), and varicella-zoster virus. The patient was placed on intravenous acyclovir and systemic corticosteroids.. A positive polymerase chain reaction signal was found only for herpes simplex virus type 1. Vision in the left eye improved from light perception to 20/25, and signs of retinal perivasculitis resolved.. The use of molecular diagnostic modalities in clinical practice may aid in determining infectious etiologies in patients with atypical clinical manifestations.

Topics: Acyclovir; Antiviral Agents; Aqueous Humor; DNA, Viral; Eye Infections, Viral; Female; Fluorescein Angiography; Fundus Oculi; Herpes Simplex; Herpesvirus 1, Human; Humans; Immunocompetence; Middle Aged; Polymerase Chain Reaction; Retinal Vein; Retinitis; Vasculitis; Viremia

Topics: 2-Aminopurine; Abnormalities, Drug-Induced; Acyclovir; Amantadine; Antiviral Agents; Cidofovir; Contraindications; Cytosine; Drug Resistance, Microbial; Eye Infections, Viral; Famciclovir; Foscarnet; Ganciclovir; Guanine; Humans; Interferon-alpha; Kidney Diseases; Lamivudine; Organophosphonates; Organophosphorus Compounds; Prodrugs; Ribavirin; Rimantadine; Trifluridine; Valacyclovir; Valine; Virus Diseases

We have previously shown that basic fibroblast growth factor (FGF-2) enhances corneal epithelial healing in different experimental models in vivo. In order to study the healing effect of this growth factor in pathological conditions of the cornea, we investigated whether topical application of FGF-2 could affect herpes keratitis in rabbits. Since HSV-1 infection is prevented in vitro by incubation with heparin, we also topically applied heparin and suramin, considering the similar interaction of herpes simplex virus and FGF-2 with cell membrane-anchored heparan sulfate.. After virus inoculation with a human BEY.2 strain, rabbits were treated with either FGF-2 (200 ng to 2 micrograms/application), heparin (250 micrograms/application) or suramin (250 micrograms/application) 4 times daily until day 14. Acyclovir and placebo administrations served as controls (n = 48 rabbits). Computerized ulcer surface analysis, clinical observations and virus recovery assays were performed.. Topical FGF-2, heparin and suramin treatment revealed a significant reduction in peak ulcer sizes, and complete epithelial healing was achieved earlier than in placebo-treated corneas. However, no significant antiviral effect of FGF-2, heparin and suramin was detectable in plaque assays from conjunctival swabs.. These experiments demonstrate that FGF-2 is effective in promoting herpetic epithelial ulcer healing, either due to its proliferative effects on epithelial cells or indirectly by occupying the sites on cell surface heparan sulfate necessary for the attachment of the virion. The latter mechanism of action is presumably the reason for the similar effect of heparin and suramin.

Topics: Acyclovir; Administration, Topical; Animals; Corneal Neovascularization; Corneal Opacity; Drug Therapy, Combination; Epithelium, Corneal; Eye Infections, Viral; Female; Fibroblast Growth Factor 2; Follow-Up Studies; Heparin; Herpesvirus 1, Human; Humans; Keratitis, Herpetic; Ophthalmic Solutions; Rabbits; Suramin; Tears; Wound Healing

In the von Szily mouse model, intracameral inoculation of herpes simplex virus type-1 (HSV-1) results in inflammation of the ipsilateral anterior segment with relative chorioretinal sparing and destructive contralateral chorioretinitis. We studied the effect of the systemic antiviral agent acyclovir (ACV) and anti-HSV-1 antibody therapy in this model. Contralateral chorioretinitis developed in none of the 18 mice receiving ACV from post-inoculation day (pid) 1 (p < 0.0001), in 6 of 10 (60%) mice when treatment was delayed until pid 7 (p = 0.40) and in 14 of 18 (77%) controls. Contralateral disease developed in 8 of 16 (50%) mice that received anti-HSV-1 antibody from pid 1 (p = 0.02), in 13 of 16 (81%) treated from pid 5 (p = 0.64), in 7 of 8 (87.5%) treated from pid 7 (p = 1.0) and in 17 of 20 (85%) controls. We conclude that early treatment with ACV or anti-HSV-1 antibody reduces the incidence of contralateral chorioretinitis in mice.

Topics: Acyclovir; Animals; Antibodies, Viral; Antiviral Agents; Chorioretinitis; Eye Infections, Viral; Female; Herpes Simplex; Herpesvirus 1, Human; Male; Mice; Mice, Inbred BALB C

A man with acquired immunodeficiency syndrome developed a generalized rash and bilateral dendritic epithelial keratitis without retinitis. Cytologic examination of superficial corneal scrapings showed many megalosyncytial giant cells that were highly characteristic of cytomegalovirus (CMV) infection. Viral cultures yielded CMV from 2 separate specimens obtained by corneal epithelial debridement from both eyes. The slightly elevated, opaque, branching, nonulcerative epitheliopathy recurred after corneal scrapings and persisted despite oral and topical antiviral therapy. Stromal keratouveitis subsequently developed. This case report confirms that CMV can produce corneal involvement and suggests that CMV keratitis may be an emergent complication of acquired immunodeficiency syndrome.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Anti-Inflammatory Agents; Antigens, Viral; Antiviral Agents; Cornea; Corneal Stroma; Cytomegalovirus; Cytomegalovirus Infections; Epithelium; Eye Infections, Viral; Fibroblasts; Fluorometholone; Humans; Keratitis; Lung; Male

Progressive outer retinal necrosis syndrome is a variant of necrotizing herpetic retinopathy, a group of retinal infections caused by the herpes viruses. It has been described only in immunosuppressed patients. We present a healthy immunocompetent 16-year-old male who suffered a bilateral progressive outer retinal necrosis. Varicella-zoster virus infection was confirmed on the basis of serologic study. Treatment with intravenous acyclovir and oral prednisone was successful.

Topics: Acyclovir; Administration, Oral; Adolescent; Antibodies, Anti-Idiotypic; Antibodies, Viral; Antiviral Agents; Disease Progression; Drug Therapy, Combination; Eye Infections, Viral; Glucocorticoids; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Immunoglobulin M; Infusions, Intravenous; Male; Prednisone; Retinal Necrosis Syndrome, Acute; Visual Acuity

To describe a case of acute retinal necrosis with concurrent encephalitis and determine the causative virus. The patient had a history of presumed acute retinal necrosis in the left eye at the age of 8 years and recurrent genital herpes.. Diagnostic anterior chamber puncture of the eye and lumbar puncture for laboratory analysis.. Polymerase chain reaction identified herpes simplex virus type 2 in the eye, and local antibody production to herpes simplex virus was demonstrated in the aqueous of this eye and in the cerebrospinal fluid.. Herpes simplex virus type 2 may cause bilateral acute retinal necrosis with long delay of fellow eye involvement and concurrent encephalitis.

Topics: Acyclovir; Adult; Antibodies, Viral; Antiviral Agents; Aqueous Humor; Cerebrospinal Fluid; Combined Modality Therapy; DNA, Viral; Encephalitis, Viral; Eye Infections, Viral; Female; Fluorescein Angiography; Fundus Oculi; Herpes Genitalis; Herpes Simplex; Herpesvirus 2, Human; Humans; Laser Therapy; Polymerase Chain Reaction; Recurrence; Retinal Necrosis Syndrome, Acute

We studied a case of acute retinal necrosis in which a 30-year delay occurred between involvement of the first and fellow eyes. After systemic treatment with acyclovir and prednisolone, the fellow eye developed a retinal detachment requiring vitrectomy and silicone oil tamponade.. The fellow eye retained a useful Snellen acuity of 20/120. In a patient who has had acute retinal necrosis, any symptoms or signs in the fellow eye, even several decades later, should alert the examining physician to the possibility of delayed involvement of the fellow eye.

Topics: Acyclovir; Eye Infections, Viral; Eyelid Diseases; Female; Herpes Simplex; Humans; Middle Aged; Prednisolone; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Silicone Oils; Time Factors; Visual Acuity; Vitrectomy

The most common causes of acute viral infections of the eye for which there are no effective antiviral drugs are the adenoviruses. Until recently, pathogenesis studies and antiviral drug testing for adenovirus-induced ocular disease were not practical because no animal model was available. However, new animal models for human adenovirus-induced ocular and respiratory infections have now made such studies possible. We assessed the in vitro and in vivo activity of ganciclovir against a genetically defined adenovirus (Ad5 wt 300) known to cause severe ocular disease. The 50% inhibitory dose (ID50) values were determined by plaque reduction assays in human cells. The ID50 values of 47 and 604 microM were determined for ganciclovir and acyclovir, respectively, against Ad5, and 26 and 152 microM, respectively against Ad8. Cotton rats were inoculated bilaterally with 10(5) plaque-forming units per eye and treated topically with ganciclovir (3%, 1%, or 0.3%) or placebo for 21 days. All inoculated eyes were culture positive on days 1-3 with increased infectivity titers, regardless of treatment. However, the incidence, duration, and titer of virus shed in eyes treated with 3% ganciclovir was reduced, and the antiadenovirus enzyme-linked immunosorbent assay titers in serum were lower in these animals. Although these differences were not statistically significant, the observed trend suggested that the highest ganciclovir dose had a suppressive effect on some disease parameters.

Topics: Acyclovir; Adenovirus Infections, Human; Adenoviruses, Human; Animals; Antibodies, Viral; Carcinoma; Enzyme-Linked Immunosorbent Assay; Eye Infections, Viral; Ganciclovir; Humans; Keratoconjunctivitis, Infectious; Lethal Dose 50; Lung Neoplasms; Ophthalmic Solutions; Sigmodontinae; Tumor Cells, Cultured; Virus Shedding

Acute retinal necrosis is a severe form of necrotizing retinitis. Acute retinal necrosis has been demonstrated to be caused by varicella-zoster virus and herpes simplex virus type 1. We treated three patients with acute retinal necrosis apparently caused by recrudescence of latent herpes simplex virus type 2. Primary viral infection was probably congenital, with documented perinatal herpes simplex virus type 2 infection in two patients. Bilateral chorioretinal scars were present in two patients, neither of whom had a history of ocular herpetic infection, suggesting that earlier subclinical chorioretinitis had occurred. In each case, periocular trauma preceded the development of retinitis by two to three weeks. These cases are evidently caused by trauma-induced reactivation of latent virus rather than the onset of a primary infection.

Topics: Acyclovir; Adult; Antibodies, Viral; Child; Child, Preschool; DNA, Viral; Eye Infections, Viral; Eye Injuries; Female; Herpes Simplex; Herpesvirus 2, Human; Humans; Male; Methylprednisolone; Retinal Necrosis Syndrome, Acute; Virus Activation

A 38-year-old bisexual man with acquired immunodeficiency syndrome (AIDS) who was being treated with oral acyclovir for herpetic stomatitis had a history of blurred vision OS that was diagnosed as cytomegalovirus retinitis. The patient refused ganciclovir administration. Two additional lesions developed OS in the succeeding four months. All clinical evidence of active retinitis cleared after zidovudine was administered, and the patient has remained free of any clinically active retinal lesions for 28 months while continuing to receive acyclovir and zidovudine. Although ganciclovir and foscarnet are the drugs of choice to treat cytomegalovirus retinitis, this observation may be fortuitous for patients whose other AIDS manifestations suggest using zidovudine rather than ganciclovir or for patients whose cytomegalovirus retinitis appears to be resistant to agents currently used to treat this infection.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Cytomegalovirus Infections; Eye Infections, Viral; Fluorescein Angiography; Follow-Up Studies; Fundus Oculi; HIV Seropositivity; Humans; Male; Retinitis; Visual Acuity; Zidovudine