Ординатура / Офтальмология / Английские материалы / Color Atlas of Herpetic Eye Disease A Practical Guide to Clinical Management_Sundmacher_2009

6.5.6 Retinal Detachment

Antiviral therapy does not affect the frequency of retinal de- tachment. These detachments are characterized by large, relatively posterior breaks, as well as a high prevalence of vitreous traction and proliferative vitreoretinopathy. Some specialists recommend to apply a retinal barrier photocoagulation so long as the hazy vitreous does not prevent an adequate view of the fundus. Retrospective, non-controlled studies suggest a lower incidence of detachment among treated patients.

However, owing to the presence of multiple, posterior, illdefined breaks associated with vitritis, the standard approach for patients with ARN, PORN, and necrotizing herpetic retini- tis is pars plana vitrectomy with silicone oil tamponade. Only in quiescent CMV retinitis with retinal detachment may gas tamponade and laser coagulation suffice. Despite rates of anatomic success of 88–100%, final vision may be limited by optical atrophy or macular involvement.

Herpes Diseases Posterior Segment

Fig. 6.1 Herpetic retinitis in a 35-year-old patient with AIDS and generalized HSV-infection. Subtle and poorly defined white patches with small satellite lesions and blood in the inner retina

Fig. 6.3 a Suspected herpetic retinitis in a 54-year-old patient without signs of immunoincompetence. Poorly defined white lesion with overlying inflamed blood vessel and superficial bleeding. b Same patient 11 days later: signs of acute retinal necrosis have developed

Fig. 6.4 CMV retinitis in a 38-year-old patient with AIDS. Clear view of the fundus reveals a small granular lesion without bleeding

with considerable vitritis and confluent white lesions. The necrotic retinitis responded well to treatment with aciclovir. VZV was suspected as the inducing agent

Fig. 6.5 CMV retinitis in a 43-year-old patient with AIDS without visual symptoms. Typical peripheral granular lesion and retinal bleedings at the central border. Clear view of the fundus

Fig. 6.6a–c CMV retinitis in a 32-year-old man. Development within 70 days without treatment. a Fresh CMV-lesion less than 7 days old. The subtle feathery lesion can easily be distinguished from two centrally located cotton wool spots. b Same lesion one week later:

first bleedings have appeared, cotton wool spots are unchanged. c Same lesion after ten weeks: enlargement, still active lesion without scarring, cotton wool spots have disappeared

Fig. 6.7 CMV retinitis in a 40-year-old patient with AIDS. Typical central lesion (“cottage cheese with ketchup”) with necrotic patches, vasculitis, superficial bleedings, and edema endangering the fovea

Fig. 6.8 CMV retinitis in a 27-year-old female, drug-addicted AIDS patient. Exsudative lesion with frosted branch angiitis

Fig. 6.9 CMV retinitis in a 34-year-old AIDS patient. Large central CMV-lesion with dominating bleedings, comprising dark deep subretinal and central superficial bleedings with interspersed fresh necrotic patches

Fig. 6.10 CMV retinitis in an immunosuppressed patient after bone marrow transplantation. Regressing peripheral lesion with large superficial bleedings, an active border and vasculitis