Progressive outer retinal necrosis in immunocompetent patients treated initially for optic neuropathy with systemic corticosteroids.
OBJECTIVE
To report two cases of progressive outer retinal necrosis occurring in immunocompetent individuals after treatment with corticosteroids for presumed optic neuropathy.


METHODS
Observational case report.


METHODS
University-based tertiary eye hospital.


METHODS
Retrospective review of existing clinical records.


RESULTS
Two patients were treated empirically with systemic corticosteroids for suspected inflammatory papillopathy. Subsequently, both were diagnosed with necrotizing herpetic retinitis with features of progressive outer retinal necrosis. Anterior chamber paracentesis confirmed varicella-zoster infection. Both patients were human immunodeficiency virus negative; one patient with rheumatoid arthritis was taking etanercept. Both became completely blind in one eye despite intensive treatment with antiviral medication intravenously and intravitreally.


CONCLUSIONS
Progressive outer retinal necrosis is not confined to patients with underlying severe immunodeficiency, such as acquired immune deficiency syndrome. Initial treatment of acute, unexplained vision loss with systemic corticosteroids may lead to catastrophic visual loss in patients with evolving necrotizing herpetic retinopathy.
Benz
Matthew S
MS
Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida 33101, USA.
Glaser
Joel S
JS
Davis
Janet L
JL
D000212:Acyclovir / Q000627:therapeutic use; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D001082:Aqueous Humor / Q000821:virology; D001766:Blindness / Q000209:etiology; D004279:DNA, Viral / Q000032:analysis; D004359:Drug Therapy, Combination; D005260:Female; D017245:Foscarnet / Q000627:therapeutic use; D015774:Ganciclovir / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use*; D006563:Herpes Zoster Ophthalmicus / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D014645:Herpesvirus 3, Human / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D016867:Immunocompromised Host; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis; D009902:Optic Neuritis / Q000175:diagnosis / Q000188:drug therapy*; D016133:Polymerase Chain Reaction; D011241:Prednisone / Q000627:therapeutic use*; D011681:Pupil Disorders / Q000175:diagnosis / Q000188:drug therapy; D015882:Retinal Necrosis Syndrome, Acute / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D012189:Retrospective Studies
D000998:Antiviral Agents; D004279:DNA, Viral; D005938:Glucocorticoids; D017245:Foscarnet; D015774:Ganciclovir; D011241:Prednisone; D000212:Acyclovir