Akutní retinální nekróza Dotaz Zobrazit nápovědu
AIM: The paper documents the cumulating appearance of 3 cases of the acute retinal necrosis (ARN) during one-year period at the district (local) eye department. It concerns the etiology, the treatment, evaluates its results and reveals the recommendations for the clinical practice. METHODS: retrospective study. RESULTS: The ARN was diagnosed in 3 patients (2 woman and 1 man) at the age of 29, 43, and 58 years. Uveitis was unilateral in all cases. All three patients were treated early with adequate systemic antiviral (acyclovir) and corticosteroids treatment, which caused improving of the clinical findings and visual acuity as well. In 2 patients, pars plana vitrectomy was performed. Despite the long-lasting chronic combined medication, during the follow-up period in these 2 patients the decrease of the visual acuity occurred. CONCLUSION: ARN is very rare, vision-threatening viral disease. The appearance of 3 cases of ARN at a local hospital is unusual. The diagnosis may be established according to the characteristic clinical findings and to its development. To determine the pathogen (varicella zoster virus in 70 %, herpes simplex virus in almost 30 %, and cytomegalovirus very rarely) is not critical for the diagnosis establishment. The early use of specific virostatic drugs is the key assumption for optimal ARN treatment, as it happened in our patients. Contrary to the adequate treatment, retinal complications may occur, and often, even after successful pars plana vitrectomy, the decrease of visual functions is possible. For the ophthalmologic practice, it is important to remember, that in case of ARN suspicion, it is urgent to start the virostatic treatment and to add corticosteroids not earlier than after 24-48 hours. In case of complications, it is necessary to contact the specialized vitreoretinal center immediately. It is necessary to inform the patient about very serious condition of the infected eye and its uncertain prognosis contrary to the adequate treatment, and about the danger to the opposite eye in case of delay of missing treatment. In case of herpetic anterior uveitis, the fundus examination, including the periphery of the retina is important.
Necrotizing herpetic retinopathies are serious, usually rapidly progressive diseases of retina. Three well defined syndromes can be outlined: acute retinal necrosis, progressive outer retinal necrosis and CMV retinitis. Two cases of acute retinal necrosis, where the clinical picture was probably influenced by the corticosteroid use are described. The overview of clinical manifestation and therapy of these syndromes is given.
INTRODUCTION: Purtscher-like retinopathy as a complication of acute pancreatitis is a disease which causes generalized retinal and macular oedema associated with retinal surface haemorrhage, which results in a permanent, sometimes partially reversible visual loss. CASE REPORT: The case report presented in this article refers to the case of a 36-year-old woman with severe acute pancreatitis. The pancreatitis led to the development of acute respiratory insufficiency with signs of septic shock and consequently, the patient was transferred to the critical care unit. The patient underwent a total of 8 surgical interventions with the revision of the abdominal cavity, necrectomy and application of the vacuum system into the abdominal cavity. Eye exams were conducted for impaired vision with the conclusion of Purtscher-like retinopathy associated with acute pancreatitis, occlusion of the central retinal artery of both eyes, confirmed by fluorescence angiography. After one year, alterations of the retina show no signs of improvement in this case; the loss of vision is permanent.Key words: acute pancreatitis Purtscher-like retinopathy.
- MeSH
- akutní nemoc MeSH
- dospělí MeSH
- fluoresceinová angiografie MeSH
- lidé MeSH
- nemoci retiny diagnóza etiologie MeSH
- okluze retinální arterie diagnóza etiologie MeSH
- pankreatitida komplikace MeSH
- respirační insuficience etiologie MeSH
- septický šok etiologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
INTRODUCTION: Ozurdex® (Allergan Pharmaceuticals, Castlebar Road, Westport, Ireland) is an intravitreal implant containing 0.7 mg of dexamethasone. It is indicated in adult patients for the treatment of diabetic macular edema, cystoid macular edema due to central retinal vein occlusion, and in patients with non-infectious uveitis. Common complications after Ozurdex® administration include an increase in intraocular pressure, cataract progression or conjunctival suffusion. Acute retinal necrosis after Ozurdex® administration is a very rare and serious complication. According to our current research, this is the fourth published case. Extreme caution must be exercised when treating immunosuppressed patients with Ozurdex®. CASE REPORT: This is case report about an immunosuppressed 68-year-old patient with diabetic macular edema, who developed acute retinal necrosis 74 days after Ozurdex® implantation. He suffers from chronic myeloid leukemia and takes the cytostatic imatinib 400 mg once per day. Urgent pars plana vitrectomy (PPV) with silicone oil instillation was performed and antiherpetic drugs were initiated intravenously. Serological examination confirmed an active infection of cytomegalovirus etiology (CMV). CONCLUSION: Acute retinal necrosis is a rare necrotizing retinitis. Corticosteroids administered intravitreally reduce the local immune response, which may cause a primary infection or reactivation of a latent viral infection.
- Klíčová slova
- acute retinal necrosis, chronic myeloid leukemia, dexamethasone, diabetic macular edema, diabetic retinopathy, hematopoietic stem cell transplantation, imatinib, imunosupression,
- MeSH
- akutní retinální nekróza * chemicky indukované komplikace diagnóza MeSH
- dexamethason škodlivé účinky MeSH
- diabetická retinopatie * komplikace MeSH
- dospělí MeSH
- injekce intravitreální MeSH
- léky implantované škodlivé účinky MeSH
- lidé MeSH
- makulární edém * diagnóza farmakoterapie etiologie MeSH
- senioři MeSH
- zraková ostrost MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- Názvy látek
- dexamethason MeSH
- léky implantované MeSH
BACKGROUND: Acute retinal necrosis is a sight-threatening disease caused by the group of herpesviruses. The aim of this paper is to report a case of acute retinal necrosis following ocular trauma in a patient initially treated with vaso-active drugs and corticosteroids for presumed ocular ischemic syndrome. CASE PRESENTATION: A 51-years-old otherwise healthy man, who suffered from sudden visual loss in the left eye following contusion, was commenced on vaso-active drugs and systemic corticosteroids for suspected ocular ischemic syndrome with extensive swelling of the optic disc and macular edema. Subsequently, vision in the initially uninvolved right eye decreased. Polymerase chain reaction of vitreous samples and retinal biopsy confirmed varicella zoster virus. Despite intensive treatment with intravenous antiviral medication, the patient became completely blind in both eyes. CONCLUSION: Initial treatment of acute, unexplained visual decrease with systemic corticosteroids may lead to visual loss in patients with developing acute retinal necrosis. Ocular trauma could have induced and corticosteroid treatment promoted reactivation of a latent viral infection in our patient.
- MeSH
- akutní retinální nekróza virologie MeSH
- antivirové látky terapeutické užití MeSH
- herpes zoster diagnóza virologie MeSH
- hormony kůry nadledvin terapeutické užití MeSH
- latence viru MeSH
- lidé středního věku MeSH
- lidé MeSH
- poranění oka komplikace MeSH
- vazokonstriktory terapeutické užití MeSH
- virus varicella zoster izolace a purifikace MeSH
- zhmoždění komplikace MeSH
- zvířata MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- Názvy látek
- antivirové látky MeSH
- hormony kůry nadledvin MeSH
- vazokonstriktory MeSH
