Acute retinal necrosis is a viral syndrome characterized by a panuveitis with necrotizing retinitis that may be complicated by retinal detachment, vaso-occlusion, optic neuropathy, and other causes of decreased visual acuity. Polymerase chain reaction testing provides a rapid and sensitive method of identifying the viral etiology of acute retinal necrosis, which is most commonly caused by herpes simplex virus type 1, herpes simplex virus type 2, and varicella zoster virus. Prompt diagnosis and treatment is paramount to prevent further vision loss. We review the management of acute retinal necrosis including systemic, local intravitreal, and combination antiviral medications. We also discuss the appropriate and inappropriate use of corticosteroids, laser retinopexy, surgical therapy, and other adjunctive measures.
Corneal ectasia is one of the rare yet potentially devastating complications encountered after refractive surgery including laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). This complication affects the primary desired outcome of LASIK, excellent uncorrected distance visual acuity (UDVA). Ectasia after refractive surgery is a progressive increase in myopia, with or without increasing astigmatism, with keratometric steepening of the cornea and topographic asymmetric inferior corneal steepening. Over time there can be associated thinning of the central and paracentral ectatic cornea. It comes to clinical attention when there is associated loss of UDVA, which is usually accompanied with loss of best corrected distance visual acuity (CDVA).(1, 2).
Primary intraocular lymphoma (PIOL) can present with uveitis, vitritis, or chorioretinal lesions. While fluorescein angiography, fundus autofluorescence, and optical coherence tomography may aid in the diagnosis of PIOL, a definitive diagnosis can only be achieved with tissue analysis. The specimen may be obtained with a vitreous or aqueous tap, however, a diagnostic pars plana vitrectomy with acquisition of diluted and undilated vitreous fluid or a chorioretinal biopsy is preferable. Once a specimen is obtained, cytopathology, flow cytometry, immunohistochemistry, gene rearrangement studies with polymerase chain reaction, and cytokine analysis can be performed to confirm the diagnosis of PIOL. Treatment is dependent on the presentation of PIOL and may include systemic chemotherapy, local intravitreal chemotherapy, radiation or a combination of therapies.
Introduction Identifying the etiology of an infectious or noninfectious uveitis syndrome is important for the clinician and patient because of the range of therapeutic and prognostic implications for each disease entity. For the majority of uveitis syndromes, a diagnosis can be made with a combination of history, clinical examination, laboratory, and radiologic testing. Diagnostic dilemmas may arise, however, when discrepancies are observed in 3 specific settings'an atypical history, atypical clinical presentation, or an inconclusive diagnostic workup that has implications from a therapy standpoint. The dilemma is further compounded when intraocular inflammation persists or worsens after seemingly appropriate local or systemic immunosuppression, which may then raise concerns for an infectious or neoplastic etiology. In these situations, diagnostic vitrectomy may greatly assist in the diagnosis and guide alternative management strategies.