PDF(Pubmed)
Abstract：
Retinal necrosis is a severe condition that threatens visual function. It is caused by viruses that are known to cause acute retinal necrosis (ARN) and progressive outer retinal necrosis (PORN), which are called necrotizing herpetic retinopathies (NHR). ARN causes severe intraocular inflammation, including anterior chamber intravitreal cells, keratic precipitate, vitreous opacity, and retinal vasculitis, whereas intraocular inflammation in PORN is considered mild or virtually absent. In addition, PORN is a disease that manifests in immunosuppressive patients, such as those with acquired immunodeficiency syndrome. Here, we present a case of unilateral retinal necrosis after chemotherapy, allogeneic peripheral blood stem cell transplantation, and cord blood transplantation for acute myelogenous leukemia (AML) in a 31-year-old male patient. AML treatment resulted in metabolic remission, and oral steroids and tacrolimus were continued. After two days, the patient visited an ophthalmologist because he noticed a sudden onset of floaters and visual field disturbance in the left eye. The peripheral retina was already necrotic in all layers, causing total retinal detachment. Intraocular inflammation, retinal opacity, or hemorrhagic spots in the fundus were not observed. His previous CD4 count was 43 cells/µL. A polymerase chain reaction test of the anterior chamber fluid revealed varicella-zoster virus (VZV), and vitrectomy was performed four days after disease onset. The excised vitreous demonstrated minimal opacity. The peripheral necrotic retina was excised, photocoagulation was performed on the residual retinal limbus, and silicone oil was injected to maintain retinal attachment. The retinal restoration was maintained under silicone oil tamponade, and corrected visual acuity improved to 20/32 without strong inflammation after vitrectomy. However, two months postoperatively, he contracted coronavirus disease 2019 (COVID-19), his general condition rapidly deteriorated, and he died. This case of retinal necrosis without inflammatory results in an immunocompromised patient and VZV detection in an intraocular sample led us to suspect PORN. However, the patchy or spread retinal whitening characteristic of PORN was completely absent, whereas the well-defined, peripheral, full-layer retinal necrosis characteristic of ARN was present. Thus, this is a rare case of VZV-induced NHR with partial features of PORN and ARN that progressed very silently.
摘要：
视网膜坏死是威胁视觉功能的严重病症。它是由已知引起急性视网膜坏死（ARN）和进行性外部视网膜坏死（PORN）的病毒引起的，称为坏死性疱疹性视网膜病（NHR）。ARN引起严重眼内炎症，包括前房玻璃体内细胞，角质沉淀，玻璃体混浊,和视网膜血管炎,而PORN的眼内炎症被认为是轻度或几乎不存在。此外,PORN是一种表现在免疫抑制患者身上的疾病，如获得性免疫缺陷综合征患者。这里,我们介绍一例化疗后单侧视网膜坏死，异基因外周血干细胞移植,和脐带血移植治疗急性髓细胞性白血病（AML）的31岁男性患者。AML治疗导致代谢缓解，继续口服类固醇和他克莫司。两天后,该患者就诊于眼科医生，因为他注意到左眼突然出现了漂浮物和视野障碍。周边视网膜在所有层都已经坏死,导致视网膜完全脱离.眼内炎症,视网膜混浊,或眼底未观察到出血点。他以前的CD4计数是43个细胞/微升。前房液的聚合酶链反应测试显示水痘-带状疱疹病毒（VZV），疾病发作后四天进行玻璃体切除术。切除的玻璃体显示出最小的不透明。切除周围坏死的视网膜，对残余的视网膜边缘进行光凝，注射硅油维持视网膜附着。视网膜修复维持在硅油填塞下，玻璃体切除术后矫正视力改善至20/32，无强烈炎症。然而,术后两个月,他感染了2019年冠状病毒病（COVID-19），他的一般状况迅速恶化，他死了.这种无炎性的视网膜坏死导致免疫功能低下的患者，眼内样品中的VZV检测使我们怀疑PORN。然而,完全不存在PORN的斑片状或扩散的视网膜增白特征，而定义明确的，外围,存在以ARN为特征的全层视网膜坏死。因此，这是一例罕见的VZV诱导的NHR,其部分特征为PORN和ARN,进展非常平静.
