valacyclovir and Retinal-Diseases

Ocular involvement due to varicella-zoster virus (VZV) infection includes conjunctivitis, scleritis, keratitis, uveitis, and necrotizing retinitis. Non-necrotizing chorioretinopathy as a late manifestation has been described.. A 50-year-old immunocompetent man developed herpes zoster ophthalmicus (HZO) in the right V1 dermatome with acute anterior uveitis (AAU) treated with oral valaciclovir and topical steroid and a chalazion in the upper eyelid with associated madarosis. Four months later, he presented recurrence of the AAU and multiple areas of chorioretinal atrophy on fundoscopy. Biopsy of the upper eyelid lesion revealed granulomatous inflammation of the eyelid margin and polymerase chain reaction study (PCR) tested positive for VZV-specific DNA. The iridocyclitis was resolved with oral valaciclovir at maximum doses with minimal choroidal pigmentary changes.. VZV ophthalmic infection starts by reactivation from the trigeminal ganglion, and it spreads to the isthmus of the pilosebaceous follicles and the epidermis, which can cause involvement of follicle and sebaceous glands. Chorioretinopathy is a rare form of late-onset non-necrotizing herpetic uveitis characterized by atrophic-appearing hypopigmented lesions, the pathogenesis of which is unknown. A direct viral infection or secondary to occlusive choroidal vasculitis is postulated at the level of the choriocapillaris and more recently it has been referred to as "choroidal vitiligo" due to possible involvement of choroidal melanocytes, as occurs in cases of cutaneous vitiligo due to VZV infection.

Topics: Atrophy; Eyelids; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Iridocyclitis; Male; Middle Aged; Retinal Diseases; Uveitis; Uveitis, Anterior; Valacyclovir; Vitiligo

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

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