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First Author: R.Iancu ROMANIA
Co Author(s): D. Stana A. Dascalu A. Popa Cherecheanu D. Serban I. Ardeleanu L. Voinea
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We present a case of a 34-years old male, admitted for progressive bilateral decreased vision after a recent episode of chickenpox (3 weeks ago).
The patient was following a drug detoxification program and had no medical history indicative of immunocompromised state.
The ophthalmological exam showed a visual acuity of light perception in both eyes. The biomicroscopy was normal. Ocular fundus in both eyes revealed a hyperemic, edematous optic disk, flame-shaped peripapillary hemorrhages, narrow arteries with segmentary occlusions, tortuous dilated veins and multiple large areas of white edematous necrotic retina and hemorrhages located in the macular region and along the blood vessels, moderate vitritis.
The patient was tested for HIV, HVB, HVC and the results were highly positive. Immediate intravenous therapy was initiated, with high doses of acyclovir and methylprednisolone. The evolution was extremely severe, with necrotic retinal detachment and no improvement of visual acuity. Ten days after admission, the patient was referred to the Vitreoretinal Department for surgical treatment. Vitrectomy, excision of the preretinal membranes and endophotocoagulation were performed in the right eye, but with no improvement of visual function.
The majority of acute retinal necrosis cases reported in the literature were of milder form, with mild to moderate vitritis, rare occurrence of retinal breaks or detachment that responded well to intravenous acyclovir, with or without prednisolone. In cases with unusual severity, an immunosuppressive associated pathology must be considered.