Korean J Ophthalmol.  2004 Jun;18(1):65-69. 10.3341/kjo.2004.18.1.65.

A Case of Atypical Progressive Outer Retinal Necrosis after Highly Active Antiretroviral Therapy

Affiliations
  • 1Department of Ophthalmology, College of Medicine, Seoul National University, Korea.
  • 2Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea.

Abstract

This is a report of an atypical case of progressive outer retinal necrosis (PORN) and the effect of highly active antiretroviral therapy (HAART) on the clinical course of viral retinitis in an acquired immunodeficiency syndrome (AIDS) patient. A 22-year-old male patient infected with human immunodeficiency virus (HIV) presented with unilaterally reduced visual acuity and a dense cataract. After cataract extraction, retinal lesions involving the peripheral and macular areas were found with perivascular sparing and the mud-cracked, characteristic appearance of PORN. He was diagnosed as having PORN based on clinical features and was given combined antiviral treatment. With concurrent HAART, the retinal lesions regressed, with the regression being accelerated by further treatment with intravenous acyclovir and ganciclovir. This case suggests that HAART may change the clinical course of PORN in AIDS patients by improving host immunity. PORN should be included in the differential diagnosis of acute unilateral cataract in AIDS patients.

Keyword

acquired immunodeficiency syndrome; highly active antiretroviral therapy; human immunodeficiency virus; progressive outer retinal necrosis; viral retinitis

MeSH Terms

AIDS-Related Opportunistic Infections/complications/*drug therapy
Acyclovir/therapeutic use
Adult
*Antiretroviral Therapy, Highly Active
Antiviral Agents/*therapeutic use
Cataract/complications
Disease Progression
Drug Therapy, Combination
Fluorescein Angiography
Ganciclovir/therapeutic use
Herpes Zoster Ophthalmicus/*drug therapy/etiology
Humans
Male
Phacoemulsification
Retinal Necrosis Syndrome, Acute/*drug therapy/etiology
Visual Acuity

Figure

  • Fig. 1 Fundus photographs of the left retina after cataract surgery. The low picture quality is due to corneal irregularities, anterior chamber reaction after cataract operation, and mild vitreous opacity. (A) White, opaque, deeply located, edematous retinal lesions in the posterior pole. (B) The peripheral yellowish white lesions spared the retinal vessels and appeared quiescent with a mud-cracked appearance.

  • Fig. 2 Fluorescein angiographic appearance at the initial manifestation (A), and after 10-day combination antiviral treatment (B). Each figure represents an image of the posterior pole about 3 minutes after injection of the fluorescein dye. Leakage from the posterior pole and the vitreous haziness decreased after the antiviral treatment.

  • Fig. 3 A montage of fundus findings taken 9 months after antiviral treatment, showing inactive outer retinal lesions with a mud-cracked appearance.


Reference

1. Foster DJ, Dugel PU, Frangieh GT, Liggett PE, Rao NA. Rapidly progressive outer retinal necrosis in the acquired immunodeficiency syndrome. Am J Ophthalmol. 1990. 110:341–348.
2. Engstrom RE Jr, Holland GN, Margolis TP, Muccioli C, Lindley JI, Belfort R Jr, Holland SP, Johnston WH, Wolitz RA, Kreiger AE. The progressive outer retinal necrosis syndrome. A variant of necrotizing herpetic retinopathy in patients with AIDS. Ophthalmology. 1994. 101:1488–1502.
3. Margolis TP, Lowder CY, Holland GN, Spaide RF, Logan AG, Weissman SS, Irvine AR, Josephberg R, Meisler DM, O'Donnelll JJ. Varicella-Zoster virus retinitis in patients with the acquired immunodeficiency syndrome. Am J Ophthalmol. 1991. 112:119–131.
4. Moorthy RS, Weinberg DV, Teich SA, Berger BB, Minturn JT, Kumar S, Rao NA, Fowell SM, Loose IA, Jampol LM. Management of varicella zoster virus retinitis in AIDS. Br J Ophthalmol. 1997. 81:189–194.
5. Ciulla TA, Rutledge BK, Morley MG, Duker JS. The progressive outer retinal necrosis syndrome: successful treatment with combination antiviral therapy. Ophthalmic Surg Lasers. 1998. 29:198–206.
6. Austin RB. Progressive outer retinal necrosis syndrome: a comprehensive review of its clinical presentation, relationship to immune status, and management. Clin Eye Vis Care. 2000. 12:119–129.
7. Guex-Crosier Y, Rochat C, Herbort CP. Necrotizing herpetic retinopathies. A spectrum of herpes virus-induced diseases determined by the immune state of the host. Ocul Immunol Inflamm. 1997. 5:259–265.
8. Banker AS, Patel A. Effect of combination antiretroviral therapy on cytomegalovirus retinitis. Indian J Ophthalmol. 2002. 50:29–33.
9. Macdonald JC, Torriani FJ, Morse LS, Karavellas MP, Reed JB, Freeman WR. Lack of reactivation of cytomegalovirus (CMV) retinitis after stopping CMV maintenance therapy in AIDS patients with sustained elevations in CD4 T cells in response to highly active antiretroviral therapy. J Infect Dis. 1998. 177:1182–1187.
Full Text Links
  • KJO
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr