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

• Woo SJ
• Yu HG
• Chung H

• KMID: 1115786
• DOI: http://doi.org/10.3341/kjo.2004.18.1.65

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.

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