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Ophthalmic Oncology pp 459–469Cite as

Viral Retinitis in the Cancer Patient

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Part of the book series: M.D. Anderson Solid Tumor Oncology Series ((MDA,volume 6))

Abstract

Viral retinitis is a vision-threatening infection of the retina that can occur in both immunocompetent and immunocompromised patients and is primarily caused by the human herpesvirus family of viruses. Prompt recognition and treatment are critical for optimal outcomes. This chapter focuses on cytomegalovirus (CMV) retinitis, acute retinal necrosis (ARN), and progressive outer retinal necrosis (PORN). Presentations of CMV retinitis range from an indolent/granular retinitis to a fulminant/edematous retinitis characterized by necrosis and hemorrhage. ARN is a vaso-occlusive necrotizing retinitis that is usually secondary to herpes zoster or HSV. PORN is characterized by primary involvement of the outer retina, minimal to no vitreous inflammation, and extremely rapid progression. Treatment of CMV retinitis consists of improving the patient’s immune status and then administering induction and maintenance antiviral therapy. For ARN, intravenous acyclovir is the standard initial treatment; oral acyclovir is then employed for variably prolonged periods. Because of PORN’s poor prognosis, a multidisciplinary approach with an infectious disease consultation is favored. In patients with viral retinitis, argon laser photocoagulation posterior to the edge of necrosis may be performed as prophylaxis against retinal detachment, which is the major cause of visual loss after acute manifestations have resolved. Retinal detachments in patients with CMV retinitis have been approached with scleral buckling, gas pneumatic retinopexy, and vitrectomy with either gas or silicone oil tamponade. Visual prognosis is guarded for patients with CMV retinitis or ARN and extremely poor for patients with PORN.

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References

  1. Biswas J, Madhavan HN, Gopal L, et al. Clinical features and virologic studies in viral retinitis. Indian J Ophthalmol 1995;43:63–8.

    PubMed  CAS  Google Scholar 

  2. Ritterband DC. Virus infections of the eye. Rev Med Virol 1998;8:187–201.

    Article  PubMed  Google Scholar 

  3. Dunn J. Viral retinitis. Ophthalmol Clin North Am 1999;12(1):109–21.

    Article  Google Scholar 

  4. Mayo GL, Tolentino MJ. Cytomegalovirus retinitis. Focal Points (educational journal of the American Academy of Ophthalmology) 2007;25(2).

    Google Scholar 

  5. Kadrmas EF, Buzney SM. Coxsackievirus B4 as a cause of adult chorioretinitis. Am J Ophthalmol 1999;127(3):347–9.

    Article  PubMed  CAS  Google Scholar 

  6. Raymond LA, Wilson CA, Linnemann CC Jr, et al. Punctate outer retinitis in acute Epstein Barr virus infection. Am J Ophthalmol 1987;104:424–6.

    PubMed  CAS  Google Scholar 

  7. Weiter JJ, Roh S. Viral infections of the choroid and retina. Infect Dis Clin North Am 1992;6(4):875–91.

    PubMed  CAS  Google Scholar 

  8. Yoser SL, Forster DJ, Rao NA. Systemic viral infections and their retinal and choroidal manifestations. Surv Ophthalmol 1993;37:313–52.

    Article  PubMed  CAS  Google Scholar 

  9. Freeman WR, Henderly DE, Wan WL, et al. Prevalence, pathophysiology, and treatment of rhegmatogenous retinal detachment in treated cytomegalovirus retinitis. Am J Ophthalmol 1987;103:527–36.

    PubMed  CAS  Google Scholar 

  10. Gangan PA, Besen G, Munguia D, et al. Macular serous exudation in patients with acquired immunodeficiency syndrome and cytomegalovirus retinitis. Am J Ophthalmol 1994;118:212–9.

    PubMed  CAS  Google Scholar 

  11. Silverstein BE, Conrad D, Margolis TP, et al. Cytomegalovirus-associated acute retinal necrosis. Am J Ophthalmol 1997;123:257–8.

    PubMed  CAS  Google Scholar 

  12. Studies of Ocular Complications of AIDS Research Group and the AIDS Clinical Trials Group. Assessment of cytomegalovirus retinitis: clinical evaluation vs. centralized grading of fundus photographs. Arch Ophthalmol 1996;114:791–805.

    Article  Google Scholar 

  13. Culbertson WW, Blumenkranz MS, Pepose JS, et al. Varicella zoster virus is a cause of the acute retinal necrosis syndrome. Ophthalmology 1986;93:559–69.

    PubMed  CAS  Google Scholar 

  14. Browning DJ, Blumenkranz MS, Culbertson WW, et al. Association of varicella zoster dermatitis with acute retinal necrosis syndrome. Ophthalmology 1987;94:602–6.

    PubMed  CAS  Google Scholar 

  15. Holland GN. Standard diagnostic criteria for the acute retinal necrosis syndrome. Executive Committee of the American Uveitis Society. Am J Ophthalmol 1994;117(5):663–7.

    PubMed  CAS  Google Scholar 

  16. Clarkson JG, Blumenkranz MS, Culbertson WW, et al. Retinal detachment following the acute retinal necrosis syndrome. Ophthalmology 1984;91:1665–8.

    PubMed  CAS  Google Scholar 

  17. Lewis JM, Nagae Y, Tano Y. Progressive outer retinal necrosis after bone marrow transplantation. Am J Ophthalmol 1996;122:892–5.

    PubMed  CAS  Google Scholar 

  18. Aizman A, Johnson MW, Elner SG. Treatment of acute retinal necrosis syndrome with oral antiviral medications. Ophthalmology 2007;114(2):307–12.

    Article  PubMed  Google Scholar 

  19. Schrier RD, Song MK, Smith IL, et al. Intraocular viral and immune pathogenesis of immune recovery uveitis in patients with healed cytomegalovirus retinitis. Retina 2006;26:165–9.

    Article  PubMed  Google Scholar 

  20. Martin DF, Parks DJ, Mellow SD, Ferris III FL, Walton RC, Remaley NA, Chew EY, Ashton P, Davis MD, Nussenblatt RB. Treatment of cytomegalovirus retinitis with an intraocular sustained-release ganciclovir implant: a randomized controlled clinical trial. Arch Ophthalmol 1994;112:1531–9.

    Article  PubMed  CAS  Google Scholar 

  21. Palay DA, Sternberg P Jr, Davis J, et al. Decrease in the risk of bilateral acute retinal necrosis by acyclovir therapy. Am J Ophthalmol 1991;112:250–5.

    PubMed  CAS  Google Scholar 

  22. Zambarakji HJ, Obi AA, Mitchell SM. Successful treatment of varicella zoster virus retinitis with aggressive intravitreal and systemic antiviral therapy. Ocul Immunol Inflamm 2002;10:41–46.

    Article  PubMed  CAS  Google Scholar 

  23. Kawaguchi T, Spencer DB, Mochizuki M. Therapy for acute retinal necrosis. Semin Ophthalmol 2008;23(4):285–90.

    Article  PubMed  Google Scholar 

  24. Ciulla TA, Rutledge BK, Morley MG, et al. The progressive outer retinal necrosis syndrome: successful treatment with combination antiviral therapy. Ophthalmic Surg Lasers 1998;29(3):198–206.

    PubMed  CAS  Google Scholar 

  25. Perez-Blazque E, Traspas R, Mendez Marin I, et al. Intravitreal ganciclovir treatment in progressive outer retinal necrosis. Am J Ophthalmol 1997;124(3):418–21.

    Google Scholar 

  26. Scott IU, Luu KM, Davis JL. Intravitreal antivirals in the management of patients with acquired immunodeficiency syndrome with progressive outer retinal necrosis. Arch Ophthalmol 2002;120:1219–22.

    PubMed  Google Scholar 

  27. Canzano JC, Morse LS, Wendel RT. Surgical repair of cytomegalovirus-related retinal detachment without silicone oil in patients with AIDS. Retina 1999;19(4):274–80.

    Article  PubMed  CAS  Google Scholar 

  28. Lau CH, Salmann J, Lightman SL. Acute retinal necrosis, features, management, and outcomes. Ophthalmology 2007;114:756–62.

    Article  PubMed  Google Scholar 

  29. Engstrom RE Jr, Holland GN, Margolis TP, et al. The progressive outer retinal necrosis syndrome: a variant of necrotizing herpetic retinopathy in patients with AIDS. Ophthalmology 1994;101:1488–502.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Ophthalmology and Visual Sciences, The University of Texas Medical Branch, Galveston, TX, USA

    Gibran S. Khurshid, Kapil G. Kapoor & Bernard F. Godley

  2. Department of Ophthalmology, The University of Texas at Houston, Houston, TX, USA

    Garvin H. Davis

Authors
  1. Gibran S. Khurshid
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  2. Garvin H. Davis
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  3. Kapil G. Kapoor
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  4. Bernard F. Godley
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Correspondence to Gibran S. Khurshid .

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Editors and Affiliations

  1. M.D. Anderson Cancer Center, Section of Ophthalmology, The University of Texas, Houston, 77030, Texas, USA

    Bita Esmaeli

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Khurshid, G.S., Davis, G.H., Kapoor, K.G., Godley, B.F. (2010). Viral Retinitis in the Cancer Patient. In: Esmaeli, B. (eds) Ophthalmic Oncology. M.D. Anderson Solid Tumor Oncology Series, vol 6. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-0374-7_37

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  • DOI: https://doi.org/10.1007/978-1-4419-0374-7_37

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