Acute retinal necrosis(ARN)is a devastating syndrome characterized by panuveitis,retinal necrosis,and a high rate of retinal detachment that may result in poor visual outcomes if not promptly diagnosed and treated.ARN...Acute retinal necrosis(ARN)is a devastating syndrome characterized by panuveitis,retinal necrosis,and a high rate of retinal detachment that may result in poor visual outcomes if not promptly diagnosed and treated.ARN is most commonly caused by viruses within the herpesvirus family.Etiologies include varicella-zoster virus,herpes simplex virus,and cytomegalovirus,and may be promptly diagnosed by polymerase chain reaction testing of aqueous or vitreous fluid.The true incidence of ARN is not known due to its rarity;as a result,clinical treatment is often guided by retrospective case series,case reports,and expert opinion.Standard of care has evolved over time but currently includes a combination of systemic and intravitreal antiviral in conjunction with topical or oral steroids and surgical therapy as needed.Combination therapy may reduce the rate of severe vision loss and increase the rate of visual acuity gain,although further studies are needed in this area.In particular for patients with mild to moderate disease,combination therapy may reduce the rate of retinal detachment.Adjunctive therapies including oral corticosteroid and prophylactic laser barricade are incompletely studied,but corticosteroid in particular,may reduce inflammation,which also is involved in the severe disease pathogenesis observed in ARN.This review discusses the advances in diagnosis and treatment of ARN,including management with combination antiviral medication and surgical interventions.展开更多
Background: Herpes virus is considered to be the pathogen of acute retinal necrosis (ARN) infection. Previous studies have that patients with ARN caused by the varicella-zoster virus (VZV) are often older, and patient...Background: Herpes virus is considered to be the pathogen of acute retinal necrosis (ARN) infection. Previous studies have that patients with ARN caused by the varicella-zoster virus (VZV) are often older, and patients with herpes simplex virus (HSV) induced ARN are considerably younger. However, in our clinical work, we find that VZV is also a pathogen in younger ARN patients. We, therefore, aimed to analyze the common etiology of younger ARN patients. Methods: A retrospective analysis was made of 20 eyes (18 patients) diagnosed as having ARN in the Department of Ophthalmology of Peking Union Medical College Hospital from 2014 to 2016. All patients were reviewed for demographic data, clinical course, clinical manifestations, time from onset to initial physician visit, duration of follow-up, visual acuity at both presentation and final visit, and treatment strategies. A paired t test was used to compare visual acuity between the presenting vision and those of final follow-up. Vitreous or aqueous specimens from 18 eyes of 18 patients were analyzed with multiplex polymerase chain reaction (mPCR)/quantitative PCR (qPCR) and xTAG-liquid chip technology (xTAG-LCT) to determine the causative virus of ARN. Results: Final best visual acuity (BCVA) improved significantly from 1.36±0.95 (median 20/400) to 0.95±0.82 (median 20/100)￠=2.714, P = 0.015) after systemic and intravitreal antiviral treatment combined with or without pars plana vitrectomy. PCR and xTAG-LCT results showed four of the five samples in the younger group (32.2±5.2 years) and 12 of the 13 samples in the senior group (53.6±4.9 years) were positive for VZV, and two of the five samples in the younger group were positive for HSV-1. Conclusions: This study demonstrates that VZV is also a common causative virus for ARN in younger patients. Considering this finding, a systemic antiviral treatment protocol should be immediately changed to intravenous ganciclovir when the patient does not respond to acyclovir before determining the causative virus, especially in younger patients.展开更多
The prompt detection and proper evaluation of necrotic retinal region are especially important for the diagnosis and treatment of acute retinal necrosis(ARN).The potential application of artificial intelligence(AI)alg...The prompt detection and proper evaluation of necrotic retinal region are especially important for the diagnosis and treatment of acute retinal necrosis(ARN).The potential application of artificial intelligence(AI)algorithms in these areas of clinical research has not been reported previously.The present study aims to create a computational algorithm for the automated detection and evaluation of retinal necrosis from retinal fundus photographs.A total of 149 wide-angle fundus photographs from40 eyes of 32 ARN patients were collected,and the U-Net method was used to construct the AI algorithm.Thereby,a novel algorithm based on deep machine learning in detection and evaluation of retinal necrosis was constructed for the first time.This algorithm had an area under the receiver operating curve of 0.92,with 86%sensitivity and 88%specificity in the detection of retinal necrosis.For the purpose of retinal necrosis evaluation,necrotic areas calculated by the AI algorithm were significantly positively correlated with viral load in aqueous humor samples(R2=0.7444,P<0.0001)and therapeutic response of ARN(R2=0.999,P<0.0001).Therefore,our AI algorithm has a potential application in the clinical aided diagnosis of ARN,evaluation of ARN severity,and treatment response monitoring.展开更多
基金This project was supported by the National Eye Institute/National Institutes of Health core grant P30-EY06360(Department of Ophthalmology,Emory University School of Medicine)National Eye Institute of the National Institutes of Health under award RO1 EY029594(SY)+1 种基金The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the views or policies of the Department of Health and Human Services,nor does mention of trade names,commercial products,or organizations imply endorsement by the U.S.GovernmentThis research was also supported an unrestricted departmental grant from Research to Prevent Blindness,Inc.to the Emory Eye Center,Emory University School of Medicine and Association for Research in Vision and Ophthalmology Mallinckrodt Young Investigator Award(SY).
文摘Acute retinal necrosis(ARN)is a devastating syndrome characterized by panuveitis,retinal necrosis,and a high rate of retinal detachment that may result in poor visual outcomes if not promptly diagnosed and treated.ARN is most commonly caused by viruses within the herpesvirus family.Etiologies include varicella-zoster virus,herpes simplex virus,and cytomegalovirus,and may be promptly diagnosed by polymerase chain reaction testing of aqueous or vitreous fluid.The true incidence of ARN is not known due to its rarity;as a result,clinical treatment is often guided by retrospective case series,case reports,and expert opinion.Standard of care has evolved over time but currently includes a combination of systemic and intravitreal antiviral in conjunction with topical or oral steroids and surgical therapy as needed.Combination therapy may reduce the rate of severe vision loss and increase the rate of visual acuity gain,although further studies are needed in this area.In particular for patients with mild to moderate disease,combination therapy may reduce the rate of retinal detachment.Adjunctive therapies including oral corticosteroid and prophylactic laser barricade are incompletely studied,but corticosteroid in particular,may reduce inflammation,which also is involved in the severe disease pathogenesis observed in ARN.This review discusses the advances in diagnosis and treatment of ARN,including management with combination antiviral medication and surgical interventions.
文摘Background: Herpes virus is considered to be the pathogen of acute retinal necrosis (ARN) infection. Previous studies have that patients with ARN caused by the varicella-zoster virus (VZV) are often older, and patients with herpes simplex virus (HSV) induced ARN are considerably younger. However, in our clinical work, we find that VZV is also a pathogen in younger ARN patients. We, therefore, aimed to analyze the common etiology of younger ARN patients. Methods: A retrospective analysis was made of 20 eyes (18 patients) diagnosed as having ARN in the Department of Ophthalmology of Peking Union Medical College Hospital from 2014 to 2016. All patients were reviewed for demographic data, clinical course, clinical manifestations, time from onset to initial physician visit, duration of follow-up, visual acuity at both presentation and final visit, and treatment strategies. A paired t test was used to compare visual acuity between the presenting vision and those of final follow-up. Vitreous or aqueous specimens from 18 eyes of 18 patients were analyzed with multiplex polymerase chain reaction (mPCR)/quantitative PCR (qPCR) and xTAG-liquid chip technology (xTAG-LCT) to determine the causative virus of ARN. Results: Final best visual acuity (BCVA) improved significantly from 1.36±0.95 (median 20/400) to 0.95±0.82 (median 20/100)￠=2.714, P = 0.015) after systemic and intravitreal antiviral treatment combined with or without pars plana vitrectomy. PCR and xTAG-LCT results showed four of the five samples in the younger group (32.2±5.2 years) and 12 of the 13 samples in the senior group (53.6±4.9 years) were positive for VZV, and two of the five samples in the younger group were positive for HSV-1. Conclusions: This study demonstrates that VZV is also a common causative virus for ARN in younger patients. Considering this finding, a systemic antiviral treatment protocol should be immediately changed to intravenous ganciclovir when the patient does not respond to acyclovir before determining the causative virus, especially in younger patients.
基金the National Natural Science Foundation of China(Nos.81870648 and 82070949)。
文摘The prompt detection and proper evaluation of necrotic retinal region are especially important for the diagnosis and treatment of acute retinal necrosis(ARN).The potential application of artificial intelligence(AI)algorithms in these areas of clinical research has not been reported previously.The present study aims to create a computational algorithm for the automated detection and evaluation of retinal necrosis from retinal fundus photographs.A total of 149 wide-angle fundus photographs from40 eyes of 32 ARN patients were collected,and the U-Net method was used to construct the AI algorithm.Thereby,a novel algorithm based on deep machine learning in detection and evaluation of retinal necrosis was constructed for the first time.This algorithm had an area under the receiver operating curve of 0.92,with 86%sensitivity and 88%specificity in the detection of retinal necrosis.For the purpose of retinal necrosis evaluation,necrotic areas calculated by the AI algorithm were significantly positively correlated with viral load in aqueous humor samples(R2=0.7444,P<0.0001)and therapeutic response of ARN(R2=0.999,P<0.0001).Therefore,our AI algorithm has a potential application in the clinical aided diagnosis of ARN,evaluation of ARN severity,and treatment response monitoring.
