title: Necrotizing and nonnecrotizing variants of herpetic uveitis with posterior segment involvement.
abstract: OBJECTIVE
  To describe the clinical characteristics and prognosis of diverse variants of herpetic uveitis with posterior segment involvement.
  
  
  METHODS
  Retrospective observational study of clinical, imaging, and laboratory data.
  
  
  RESULTS
  Twenty-five patients were classified as having typical acute retinal necrosis (ARN) and 13 patients as not having ARN (non-ARN). Age at symptom onset, sex, bilateral involvement, and prevalence of viral species were not significantly different between patients in the ARN and non-ARN groups. All patients in the ARN group had necrotic retinal lesions that progressed quickly, whereas only 4 of 13 patients (31%) in the non-ARN group (P < .001) had necrotic retinal lesions that progressed slowly. Necrotizing variants were noted in 29 of 38 patients (76%), including 4 patients with slowly progressing lesions. Nine remaining patients in the non-ARN group had non-necrotizing posterior uveitis without retinal lesions; their cases were characterized by vitritis, vasculitis, and/or papillitis, or as panuveitis without any distinct features (5 patients [38.5%]). At 6 months' follow-up, visual acuity of less than 0.1 developed in 13 of 25 patients (52%) in the ARN group and in 4 of 13 patients (31%) in the non-ARN group (P = .30).
  
  
  CONCLUSIONS
  Herpes simplex and varicella zoster viruses can cause a wide spectrum of clinical manifestations ranging from severe ARN to slow-progressing necrotizing and non-necrotizing types of inflammation. The non-ARN variants are currently underdiagnosed. Patients with these variants could potentially benefit from earlier recognition and treatment.
authors.affiliation: Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Barbara
authors.initials: B
authors.lastname: Wensing
authors.forename: Jolanda D F
authors.initials: JD
authors.lastname: de Groot-Mijnes
authors.forename: Aniki
authors.initials: A
authors.lastname: Rothova
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use; D001082:Aqueous Humor / Q000821:virology; D003131:Combined Modality Therapy; D004279:DNA, Viral / Q000032:analysis; D004359:Drug Therapy, Combination; D015828:Eye Infections, Viral / Q000175:diagnosis / Q000628:therapy / Q000821:virology*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006561:Herpes Simplex / Q000175:diagnosis / Q000628:therapy / Q000821:virology*; D006563:Herpes Zoster Ophthalmicus / Q000175:diagnosis / Q000628:therapy / Q000821:virology*; D018259:Herpesvirus 1, Human / Q000235:genetics / Q000302:isolation & purification; D014645:Herpesvirus 3, Human / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D015882:Retinal Necrosis Syndrome, Acute / Q000175:diagnosis / Q000628:therapy / Q000821:virology*; D012189:Retrospective Studies; D015866:Uveitis, Posterior / Q000175:diagnosis / Q000628:therapy / Q000821:virology*; D014792:Visual Acuity; D014821:Vitrectomy; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D005938:Glucocorticoids