Clinical features, management and outcomes of progressive outer retinal necrosis (PORN) in southern Thailand.
OBJECTIVE
To study the demographics, clinical features, treatment, and visual outcomes of progressive outer retinal necrosis (PORN) in a group of Thai patients.


METHODS
All cases of AIDS with a clinical diagnosis of PORN in a major tertiary referral hospital in southern Thailand between January 2003 and June 2007 were retrospectively reviewed. Demographic data, clinical features, treatment regimens, and visual outcomes were analyzed.


RESULTS
Seven patients (11 eyes) were studied. The mean age was 44.7 years. The median CD4 count was 12 cells/mm3. A known history of cutaneous zoster was documented in 57% of cases. The median follow-up period was 17 weeks. Fifty-seven percent of the patients had bilateral disease. A majority of eyes (45.4%) had initial visual acuity of less than 20/50 to equal to or better than 20/200. About two-thirds of the eyes had anterior chamber cells. Vitritis and retinal lesions scattered throughout both posterior pole and peripheral retina were found in 72.7%. Either intravenous acyclovir in combination with intravitreal ganciclovir injections or intravenous aclyclovir alone was used for initial treatment. Retinal detachment occurred in 54.5%. Final visual acuity worsened (loss of 3 lines on the ETDRS chart or more) in 60%. Visual acuity was no light perception in 45.5% at the final recorded follow-up.


CONCLUSIONS
Demographics, clinical features and treatment outcomes of PORN in this group of Thai patients were comparable with studies from other countries. Visual prognosis is still poor with current treatment regimens.
Sittivarakul
Wantanee
W
Department of Ophthalmology, Songklanagarind Hospital, Prince of Songkla University, Hat Yai, Songkhla, Thailand. wantanee_sitti@yahoo.com
Aui-aree
Nipat
N
D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000473:pathology; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000212:Acyclovir / Q000627:therapeutic use*; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D044466:Asian People; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D015774:Ganciclovir / Q000627:therapeutic use*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012163:Retinal Detachment / Q000150:complications; D015882:Retinal Necrosis Syndrome, Acute / Q000188:drug therapy* / Q000473:pathology / Q000821:virology; D012189:Retrospective Studies; D013785:Thailand; D016896:Treatment Outcome; D014792:Visual Acuity
D000998:Antiviral Agents; D015774:Ganciclovir; D000212:Acyclovir