Multiple recurrent branch retinal artery occlusions associated with varicella zoster virus.
OBJECTIVE
The authors describe an immunocompetent patient who developed multiple recurrent branch retinal artery occlusions (BRAOs) associated with the varicella zoster virus (VZV).


METHODS
A 69-year-old woman with mild bilateral vitritis developed superior and inferior BRAOs in her right eye with decreased visual acuity to 20/40, and a peripheral BRAO inferotemporally in her left eye. One month later, the inferotemporal BRAO progressed proximally in her left eye with a decrease of visual acuity to 20/40. After an extensive negative systemic evaluation, she underwent a diagnostic pars plana vitrectomy of her right eye.


RESULTS
Vitreous fluid was positive for VZV DNA by polymerase chain reaction (PCR). The patient was treated with intravenous acyclovir and systemic oral steroids. After remaining disease free for 3 months, the patient had two recurrences: 1) a mild vitritis and 2) development of a new superior temporal artery occlusion in the left eye. Both recurrences were treated with oral acyclovir and systemic steroids. The patient remained recurrence free for 12 months on a maintenance dose of oral acyclovir, and for 4 additional months without acyclovir.


CONCLUSIONS
Varicella zoster virus can be associated with the syndrome of multiple recurrent BRAOs. The diagnosis of VZV-associated BRAO can be established by PCR of intraocular fluid.
Zamora
R L
RL
Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO 63110, USA.
del Priore
L V
LV
Storch
G A
GA
Gelb
L D
LD
Sharp
J
J
D000212:Acyclovir / Q000627:therapeutic use; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006563:Herpes Zoster Ophthalmicus / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D014645:Herpesvirus 3, Human / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D007121:Immunocompetence; D016133:Polymerase Chain Reaction; D011241:Prednisone / Q000627:therapeutic use; D012008:Recurrence; D015356:Retinal Artery Occlusion / Q000188:drug therapy / Q000473:pathology / Q000821:virology*; D014792:Visual Acuity; D014821:Vitrectomy; D014822:Vitreous Body / Q000473:pathology / Q000821:virology
D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D004279:DNA, Viral; D011241:Prednisone; D000212:Acyclovir