title: Correlation of Clinical Outcomes with Quantitative Polymerase Chain Reaction DNA Copy Number in Patients with Acute Retinal Necrosis.
abstract: OBJECTIVE
  To correlate visual acuity outcomes and clinical features with quantitative PCR DNA copy number in patients with acute retinal necrosis (ARN).
  
  
  METHODS
  Retrospective, consecutive case series.
  
  
  RESULTS
  In total, 14 eyes of 13 patients were diagnosed with ARN, based on the American Uveitis Society criteria, and were followed for a mean of 324.5 days (median 250.5 days, SD ± 214 days). Anterior chamber fluid analyzed by quantitative PCR identified viral DNA in 11 of 14 eyes (78.5%). Varicella zoster virus (VZV) was identified in seven eyes (50%) and herpes simplex virus (HSV) in four eyes (28.5%). Mean DNA copy number was 7.9 × 106/mL (median 2.10 × 106/mL, range: 0-5.60 × 107/mL). Eyes with quantitative PCR DNA copy number of ≥5.0 × 106/mL (n = 6 eyes) had worse baseline visual acuity (logMAR 1.48 ± 0.71 vs 0.94 ± 0.76, p = 0.196) and final visual acuity (logMAR 2.10 ± 0.60 vs 0.82 ± 0.81, p = 0.007) compared with patients with a DNA copy number <5.0 × 106/mL (n = 8 eyes). Patients with a DNA copy number of ≥5.0 × 106/mL were more likely to have at least 5 clock hours of retinitis on funduscopic exam (p = 0.03) and developed retinal detachment more frequently (p = 0.08).
  
  
  CONCLUSIONS
  Quantitative DNA copy number of ≥5.0 × 106/mL is associated with more extensive retinitis, worse visual acuity, and development of retinal detachment in patients with acute retinal necrosis.
authors.affiliation: a Uveitis Unit, The Retina Service of Wills Eye Hospital , Philadelphia , Pennsylvania , USA.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Calvo
authors.affiliation: a Uveitis Unit, The Retina Service of Wills Eye Hospital , Philadelphia , Pennsylvania , USA.|b Mid-Atlantic Retina , Philadelphia , Pennsylvania , USA.
authors.forename: Mohammed Ali
authors.initials: MA
authors.lastname: Khan
authors.affiliation: a Uveitis Unit, The Retina Service of Wills Eye Hospital , Philadelphia , Pennsylvania , USA.|b Mid-Atlantic Retina , Philadelphia , Pennsylvania , USA.
authors.forename: Sonia
authors.initials: S
authors.lastname: Mehta
authors.affiliation: a Uveitis Unit, The Retina Service of Wills Eye Hospital , Philadelphia , Pennsylvania , USA.|b Mid-Atlantic Retina , Philadelphia , Pennsylvania , USA.
authors.forename: Sunir J
authors.initials: SJ
authors.lastname: Garg
authors.affiliation: a Uveitis Unit, The Retina Service of Wills Eye Hospital , Philadelphia , Pennsylvania , USA.|b Mid-Atlantic Retina , Philadelphia , Pennsylvania , USA.
authors.forename: James P
authors.initials: JP
authors.lastname: Dunn
mesh_terms: D000212:Acyclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use; D001082:Aqueous Humor / Q000821:virology; D004279:DNA, Viral / Q000032:analysis*; D015828:Eye Infections, Viral / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D005260:Female; D018628:Gene Dosage; D006561:Herpes Simplex / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D006563:Herpes Zoster Ophthalmicus / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D014645:Herpesvirus 3, Human / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D060888:Real-Time Polymerase Chain Reaction; D015882:Retinal Necrosis Syndrome, Acute / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D012189:Retrospective Studies; D018139:Simplexvirus / Q000235:genetics / Q000302:isolation & purification; D013223:Statistics as Topic; D000077483:Valacyclovir; D014633:Valine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D014633:Valine; D000077483:Valacyclovir; D000212:Acyclovir
keywords: Acute retinal necrosis; herpes simplex virus; necrotizing retinitis; polymerase chain reaction; retinitis