Meriem Hafidi1, Hélène Janin-Manificat2, Philippe Denis3, Bruce Charleux4, Muriel Rabilloud5, Andre Boibieux6, Carole Burillon7, Laurent Kodjikian3, Emilie Frobert8. 1. Department of Ophthalmology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France. Electronic address: meriem.hafidi1@gmail.com. 2. Department of Ophthalmology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; La Coline Ophthalmological Center, Clinique l'Infirmerie Protestante, Caluire et Cuire, France. 3. University of Lyon, Lyon, France; Department of Ophthalmology, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France. 4. Department of Ophthalmology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France. 5. University of Lyon, Lyon, France; Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France; Laboratory of Biometry and Evolutive Biology, CNRS, UMR 5558, Equipe Biostatistique-Santé, Villeurbanne, France. 6. Department of Infectious Diseases, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France. 7. Department of Ophthalmology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; University of Lyon, Lyon, France. 8. University of Lyon, Lyon, France; Laboratory of Virology, Institut des Agents Infectieux (IAI) de Lyon, Hospices Civils de Lyon, Lyon, France; Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, Centre National de la Recherche Scientifique (CNRS) UMR5308, Ecole Nationale Supérieure de Lyon (ENS), Equipe Virpath, Lyon, France.
Abstract
PURPOSE: To evaluate outcomes of patients treated with intensive intravitreal therapy and to describe the evolution of quantitative real-time polymerase chain reaction (qPCR) in patients treated for acute retinal necrosis (ARN) syndrome. DESIGN: Retrospective observational case series. METHODS: This study included 25 eyes of 24 patients with ARN who were treated and followed up in 2 departments of ophthalmology in Lyon, France. Assessed outcomes included qPCR viral load profile during treatment, number of antiviral intravitreal injections (IVT), retinal detachment rate, and best-corrected visual acuity. RESULTS: Final visual acuity was 20/200 or less in 20% of cases; the rate of retinal detachment was 16%. Viral load kinetics changed in 3 phases: a first plateau period that was not consistent, a logarithmic decrease phase, and a negativation phase. Mean decay of the logarithm of the viral load was estimated at 0.076 per day; mean time of negativation was 56.1 days. Median IVT number was 9 (range, 0-28). Ten patients were treated with injections until the viral load was undetectable. Resistance to acyclovir was observed in a patient with a prolonged initial plateau of the viral load. CONCLUSIONS: Numerous and prolonged IVTs, used as adjunctive therapy, could improve the prognosis of treated patients by decreasing the risk of retinal detachment and improving visual acuity. QPCR enables monitoring of the response to treatment and can provide evidence for resistance to antiviral treatment by enabling the detection of cases with a prolonged initial plateau of viral load.
PURPOSE: To evaluate outcomes of patients treated with intensive intravitreal therapy and to describe the evolution of quantitative real-time polymerase chain reaction (qPCR) in patients treated for acute retinal necrosis (ARN) syndrome. DESIGN: Retrospective observational case series. METHODS: This study included 25 eyes of 24 patients with ARN who were treated and followed up in 2 departments of ophthalmology in Lyon, France. Assessed outcomes included qPCR viral load profile during treatment, number of antiviral intravitreal injections (IVT), retinal detachment rate, and best-corrected visual acuity. RESULTS: Final visual acuity was 20/200 or less in 20% of cases; the rate of retinal detachment was 16%. Viral load kinetics changed in 3 phases: a first plateau period that was not consistent, a logarithmic decrease phase, and a negativation phase. Mean decay of the logarithm of the viral load was estimated at 0.076 per day; mean time of negativation was 56.1 days. Median IVT number was 9 (range, 0-28). Ten patients were treated with injections until the viral load was undetectable. Resistance to acyclovir was observed in a patient with a prolonged initial plateau of the viral load. CONCLUSIONS: Numerous and prolonged IVTs, used as adjunctive therapy, could improve the prognosis of treated patients by decreasing the risk of retinal detachment and improving visual acuity. QPCR enables monitoring of the response to treatment and can provide evidence for resistance to antiviral treatment by enabling the detection of cases with a prolonged initial plateau of viral load.
Authors: Chiara Mapelli; Paolo Milella; Caterina Donà; Marco Nassisi; Silvia Osnaghi; Francesco Viola; Carlo Agostoni; Francesca Minoia; Giovanni Filocamo Journal: Front Pediatr Date: 2022-04-01 Impact factor: 3.418