BACKGROUND: Progressive outer retinal necrosis (PORN) is an ocular disease in individuals with AIDS and is associated with substantial morbidity. The optimal management of PORN and its clinical course in the HAART era is unclear. OBJECTIVE: We report a case of successfully managed PORN that provides insight into the monitoring and treatment of this disease. STUDY DESIGN: Intravitreal injections and intravenous therapy targeted towards varicella zoster virus (VZV) were used to treat PORN. HAART was initiated for HIV-1 therapy. Serial PCR for VZV was performed on aqueous humor to monitor the clinical course. RESULTS: The presence of VZV DNA from aqueous humor correlated with clinical exacerbations of disease. Initiation of twice weekly intravitreal injections with dual antiviral drugs appeared to be an important therapeutic intervention that resulted in remission of PORN. Secondary prophylaxis against VZV was successfully withdrawn after HAART induced partial immune recovery. CONCLUSION: In addition to aggressive therapy with intravitreal injections, HAART and quantitative measurements of VZV DNA from aqueous humor have important roles in the management of PORN. A multidisciplinary approach involving specialists in infectious diseases, ophthalmology, and clinical microbiology will improve the chances for successful long-term outcomes.
BACKGROUND: Progressive outer retinal necrosis (PORN) is an ocular disease in individuals with AIDS and is associated with substantial morbidity. The optimal management of PORN and its clinical course in the HAART era is unclear. OBJECTIVE: We report a case of successfully managed PORN that provides insight into the monitoring and treatment of this disease. STUDY DESIGN: Intravitreal injections and intravenous therapy targeted towards varicella zoster virus (VZV) were used to treat PORN. HAART was initiated for HIV-1 therapy. Serial PCR for VZV was performed on aqueous humor to monitor the clinical course. RESULTS: The presence of VZV DNA from aqueous humor correlated with clinical exacerbations of disease. Initiation of twice weekly intravitreal injections with dual antiviral drugs appeared to be an important therapeutic intervention that resulted in remission of PORN. Secondary prophylaxis against VZV was successfully withdrawn after HAART induced partial immune recovery. CONCLUSION: In addition to aggressive therapy with intravitreal injections, HAART and quantitative measurements of VZV DNA from aqueous humor have important roles in the management of PORN. A multidisciplinary approach involving specialists in infectious diseases, ophthalmology, and clinical microbiology will improve the chances for successful long-term outcomes.
Authors: George K Siberry; Mark J Abzug; Sharon Nachman; Michael T Brady; Kenneth L Dominguez; Edward Handelsman; Lynne M Mofenson; Steve Nesheim Journal: Pediatr Infect Dis J Date: 2013-11 Impact factor: 2.129
Authors: Murli U Purswani; Brad Karalius; Tzy-Jyun Yao; D Scott Schmid; Sandra K Burchett; George K Siberry; Kunjal Patel; Russell B Van Dyke; Ram Yogev; Robert H Lurie; Ram Yogev; Margaret Ann Sanders; Kathleen Malee; Scott Hunter; William Shearer; Mary Paul; Norma Cooper; Lynnette Harris; Murli Purswani; Mahboobullah Baig; Anna Cintron; Ana Puga; Sandra Navarro; Patricia Garvie; James Blood; Sandra Burchett; Nancy Karthas; Betsy Kammerer; Andrew Wiznia; Marlene Burey; Molly Nozyce; Arry Dieudonne; Linda Bettica; Susan Adubato; Janet Chen; Maria Garcia Bulkley; Latreaca Ivey; Mitzie Grant; Katherine Knapp; Kim Allison; Megan Wilkins; Midnela Acevedo-Flores; Heida Rios; Vivian Olivera; Margarita Silio; Medea Jones; Patricia Sirois; Stephen Spector; Kim Norris; Sharon Nichols; Elizabeth McFarland; Alisa Katai; Jennifer Dunn; Suzanne Paul; Gwendolyn Scott; Patricia Bryan; Elizabeth Willen Journal: Clin Infect Dis Date: 2015-09-18 Impact factor: 9.079
Authors: Lynne M Mofenson; Michael T Brady; Susie P Danner; Kenneth L Dominguez; Rohan Hazra; Edward Handelsman; Peter Havens; Steve Nesheim; Jennifer S Read; Leslie Serchuck; Russell Van Dyke Journal: MMWR Recomm Rep Date: 2009-09-04