This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this link to a friend Similar articles in this journal Similar articles in PubMed Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Balansard, B Articles by LeHoang, P Search for Related Content PubMed PubMed Citation Articles by Balansard, B Articles by LeHoang, P

Necrotising retinopathies simulating acute retinal necrosis syndrome

¹ Department of Ophthalmology, Pitié-Salpêtrière Hospital, Paris, France
² Institut de Puériculture, Paris, France
³ Laboratoire de Virologie, Hôpital Saint-Vincent de Paul, Paris, France
⁴ Doheny Eye Institute and the Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

Correspondence to:
Correspondence to:
P LeHoang MD PhD
Department of Ophthalmology, Pitié-Salpêtrière Hospital, 43 bd de l’Hôpital, Paris, France; bahram.bodaghi{at}psl.ap-hop-paris.fr

Aim: To determine an aetiological diagnosis in patients presenting with necrotising retinopathies that simulate acute retinal necrosis (ARN).

Methods: Retrospective non-comparative case series. The charts of 16 patients presenting with a clinical impression of ARN at Pitié-Salpêtrière Hospital, Paris, France, between 1994 and 1999, who required initial antiviral therapy were reviewed. All of the patients had extensive laboratory tests. Anterior chamber paracentesis was performed on 14 patients and evaluated by polymerase chain reaction (PCR) and/or the Witmer-Goldmann coefficient to determine the cause of retinitis. Three of the 14 cases also had diagnostic vitrectomy. Responses to specific treatment, initiated based on laboratory results, and the final outcome were evaluated.

Results: Seven of the 16 patients were female and nine were male. The retinitis was bilateral in five patients and unilateral in 11 patients. The average age of the patients at presentation was 53.6 years. 13 patients were immune deficient for various reasons. Upon initial presentation, the patients’ visual acuities were less than 20/200 in 68% of the affected eyes. The final diagnoses, based on laboratory data and therapeutic response were toxoplasmic retinochoroiditis (62.5%), syphilitic retinitis (12.5%), aspergillus endophthalmitis (12.5%), Behçet’s disease (6.2%), and intraocular lymphoma (6.2%). Visual acuity was stabilised or improved in 12 patients (75%). Two patients with aspergillosis died despite antifungal therapy.

Conclusions: Toxoplasmic retinochoroiditis is the major cause of retinal necrosis that simulates ARN, and PCR analysis of the aqueous humour is helpful in establishing the diagnosis. Such atypical toxoplasma retinochoroiditis may be associated with poor visual outcome.

Abbreviations: AH, aqueous humour; ARN, acute retinal necrosis; CMV, cytomegalovirus; EBV, Epstein-Barr virus; HSV, herpes simplex virus; PCR, polymerase chain reaction; VZV, varicella zoster virus

Keywords: necrotising retinopathies; retinal necrosis syndrome; Behçet’s disease; syphilis; toxoplasmosis

This article has been cited by other articles:

				A. Fekkar, B. Bodaghi, F. Touafek, P. Le Hoang, D. Mazier, and L. Paris Comparison of Immunoblotting, Calculation of the Goldmann-Witmer Coefficient, and Real-Time PCR Using Aqueous Humor Samples for Diagnosis of Ocular Toxoplasmosis J. Clin. Microbiol., June 1, 2008; 46(6): 1965 - 1967. [Abstract] [Full Text] [PDF]

				J. L Orefice, R. A Costa, F. Orefice, W. Campos, D. da Costa-Lima Jr, and I. U Scott Vitreoretinal morphology in active ocular toxoplasmosis: a prospective study by optical coherence tomography Br. J. Ophthalmol., June 1, 2007; 91(6): 773 - 780. [Abstract] [Full Text] [PDF]