Original Articles
Viral causes of the acute retinal necrosis syndrome

https://doi.org/10.1016/S0002-9394(99)00316-5Get rights and content

Abstract

PURPOSE: The primary goal of this study was to determine the viral cause of the acute retinal necrosis syndrome in 28 patients (30 eyes). A secondary goal was to investigate possible associations between viral cause and patient age, and viral cause and central nervous system disease.

METHODS: A retrospective case series in which we reviewed the laboratory results and clinical histories of 28 patients (30 eyes) diagnosed with acute retinal necrosis syndrome, from whom vitreous or aqueous specimens were received, for diagnostic evaluation using previously described polymerase chain reaction–based assays.

RESULTS: Varicella-zoster virus, herpes simplex virus, and cytomegalovirus (CMV) DNA were detected in aqueous and/or vitreous specimens from 27 of 28 patients (29 of 30 eyes with a clinical history of acute retinal necrosis syndrome). No sample was positive for DNA from more than one virus. Varicella-zoster virus DNA was detected in 13 patients (15 eyes). Median age was 57 years. Herpes simplex virus type 1 DNA was detected in seven patients (seven eyes). Median age was 47 years. Six of these patients had a history of herpes simplex virus encephalitis. Herpes simplex virus type 2 DNA was detected in six patients (six eyes). Median age was 20 years. Three of these patients had a likely history of meningitis. Cytomegalovirus DNA was detected in one patient who was immunosuppressed iatrogenically. No viral DNA was detected in one patient from whom a sample was taken after 6 weeks of acyclovir therapy.

CONCLUSIONS: The data suggest that varicella-zoster virus or herpes simplex virus type 1 cause acute retinal necrosis syndrome in patients older than 25 years, whereas herpes simplex virus type 2 causes acute retinal necrosis in patients younger than 25 years. A history of central nervous system infection in a patient with acute retinal necrosis syndrome suggests that herpes simplex virus is likely to be the viral cause.

Section snippets

Methods

All patients with a diagnosis of acute retinal necrosis syndrome, based on the characteristic clinical criteria described by the Executive Committee of the American Uveitis Society,2 from whom undiluted vitreous and aqueous specimens were received for diagnostic evaluation from December 1993 to July 1998, were included. The clinical criteria described by the American Uveitis Society for the diagnosis of acute retinal necrosis syndrome include the findings of focal, well-demarcated areas of

Results

Laboratory results and clinical histories were analyzed from 28 patients (30 eyes) diagnosed with acute retinal necrosis syndrome from whom vitreous and aqueous biopsy specimens were received for diagnostic evaluation using polymerase chain reaction–based assays. Cytomegalovirus, varicella-zoster virus, or herpes simplex virus DNA was detected in 29 of 30 eyes. No sample was positive for DNA from more than one virus.

Varicella-zoster virus DNA was detected in 12 vitreous and six aqueous

Discussion

In this retrospective study, we reviewed the laboratory results and clinical histories of 28 patients (30 eyes) diagnosed with acute retinal necrosis syndrome, from whom either vitreous or aqueous specimens were analyzed by polymerase chain reaction–based assays for the detection of viral DNA. Varicella-zoster virus DNA was detected in the vitreous or aqueous of 13 patients (15 eyes); the median age at the time of infection was 57 years (mean age, 52.7 years). Herpes simplex type 1 virus DNA

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