An Unusual Case of Exudative Retinal Detachment in a 6-Year-Old Child with Acute Retinal Necrosis.

IF 2.6 4区 医学 Q2 OPHTHALMOLOGY Ocular Immunology and Inflammation Pub Date : 2024-12-21 DOI:10.1080/09273948.2024.2444512
Rakshita Deepak Kene, Saloni Desai, Chetan Rao, Parthopratim Dutta Majumder
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Abstract

Purpose: To report a case of exudative retinal detachment (ERD) in a child with Acute retinal necrosis (ARN).

Method: Retrospective Chart Review.

Result: A six-year-old boy presented with anterior uveitis with hypopyon and exudative retinal detachment with peripheral confluent patches of retinitis in the left eye. Examination of the right eye was unremarkable. B scan ultrasonography of the left eye revealed moderate vitreous echoes along with a membrane in the inferior quadrant persisting on low gains indicating localised inferior retinal detachment with the presence of shifting fluid. Fundus examination under general anaesthesia failed to locate any break in the retina. Polymerase chain reaction from the aqueous aspirate was positive for Herpes Simplex Virus (HSV)-I. The child was treated with intravenous acyclovir three times a day, intravitreal injection of ganciclovir and subsequently started on oral steroids (0.5 mg/kg/day). While continuing antiviral treatment, dose of corticosteroid was gradually increased to 1 mg/kg/day. Intravenous injection of acyclovir for 28 days and six intravitreal injections with corticosteroid led to complete resolution of ERD. Six months after initial presentation, the patient underwent lens aspiration with intraocular lens (IOL) implantation under general anaesthesia, under antiviral coverage. Following surgery, his BCVA in the left eye improved to 6/12.

Conclusion: ERD is a rare complication of ARN, typically associated with HSV infection. Meticulous monitoring and combined systemic and local antiviral therapy, complemented by judicious corticosteroid use, are essential for managing such cases effectively.

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6岁儿童急性视网膜坏死罕见渗出性视网膜脱离1例。
目的:报告一例渗出性视网膜脱离(ERD)患儿急性视网膜坏死(ARN)。方法:回顾性图表复习。结果:1例6岁男童以左眼前葡萄膜炎伴低网膜及渗出性视网膜脱离合并周围性视网膜炎。右眼检查无明显异常。左眼B超显示中度玻璃体回声,伴下象限膜持续低增益,提示局部下视网膜脱离伴移位液。全麻下眼底检查未发现视网膜有任何破裂。从水吸出的聚合酶链反应阳性的单纯疱疹病毒(HSV)- 1。患儿接受每日3次静脉注射阿昔洛韦,玻璃体内注射更昔洛韦,随后开始口服类固醇(0.5 mg/kg/天)。在继续抗病毒治疗的同时,皮质类固醇的剂量逐渐增加到1mg /kg/天。静脉注射阿昔洛韦28天,玻璃体内注射皮质类固醇6次,导致ERD完全消退。初次就诊6个月后,患者在全身麻醉和抗病毒药物覆盖下接受晶状体吸出和人工晶状体植入术。手术后,他的左眼BCVA改善到6/12。结论:ERD是一种罕见的ARN并发症,通常与HSV感染有关。严密的监测和综合的全身和局部抗病毒治疗,辅以明智的皮质类固醇使用,对于有效管理此类病例至关重要。
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来源期刊
CiteScore
6.20
自引率
15.20%
发文量
285
审稿时长
6-12 weeks
期刊介绍: Ocular Immunology & Inflammation ranks 18 out of 59 in the Ophthalmology Category.Ocular Immunology and Inflammation is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and vision scientists. Published bimonthly, the journal provides an international medium for basic and clinical research reports on the ocular inflammatory response and its control by the immune system. The journal publishes original research papers, case reports, reviews, letters to the editor, meeting abstracts, and invited editorials.
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