Haihui Wei, WenJing Xu, Hai Jiang, Siyan Jin, Xiaoli Liu
{"title":"与急性视网膜坏死非手术治疗相关的预后因素","authors":"Haihui Wei, WenJing Xu, Hai Jiang, Siyan Jin, Xiaoli Liu","doi":"10.1038/s41433-024-03319-3","DOIUrl":null,"url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Objectives</h3><p>To analyse the prognostic factors for visual acuity in acute retinal necrosis (ARN) patients treated non-surgically.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>The clinical data of ARN patients who visited our hospital from January 2010 to January 2023 were retrospectively analysed.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Twenty-four patients (29 eyes) were included. Aqueous humour samples were collected from 20 out of 29 eyes, and PCR confirmed that 85% (17/20) of the eyes had VZV infection, 10% (2/20) had CMV infection, and 5% (1/20) had HSV infection. All patients were treated with intravenous antiviral agents. Intravitreal ganciclovir and oral corticosteroids were given according to the patients’ wishes. A comparison of visual acuity at the time of first identification of inactive ARN with that at the first visit revealed that 16 (55.2%) eyes improved and 13 (44.8%) did not improve. Logistic regression analysis revealed that risk factors for failure to improve vision after treatment included retinal detachment (odds ratio [OR],33.75; 95% CI, 3.245–351.067; <i>P</i> = 0.003), necrotising retinitis involving the posterior pole (odds ratio [OR],8.167; 95% CI, 1.297–51.403, <i>P</i> = 0.025), and arteritis involving the large retinal arteries (odds ratio [OR],9.167; 95% CI, 1.493–56.297; <i>P</i> = 0.017). The VZV viral load in the aqueous humour at initial presentation was significantly associated with visual prognosis (<i>r</i> = 0.688, <i>P</i> = 0.013), retinal detachment (<i>τ</i> = 0.597, <i>P</i> = 0.021) and the extent of retinal necrosis (<i>τ</i> = 0.57, <i>P</i> = 0.027). The neutrophil to lymphocyte ratio (NLR) of VZV-infected patients at first presentation was significantly correlated with the prognosis of visual acuity (<i>r</i> = 0.616, <i>P</i> = 0.033) and retinal detachment (<i>τ</i> = 0.728, <i>P</i> = 0.004).</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>High NLR and viral DNA copy number in the aqueous humour at the initial presentation, as well as subsequent retinal detachment, necrotising retinitis involving the posterior pole, and arteritis involving the large retinal arteries were risk factors for poor visual prognosis in VZV-infected ARN patients.</p>","PeriodicalId":12125,"journal":{"name":"Eye","volume":null,"pages":null},"PeriodicalIF":2.8000,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prognostic factors associated with acute retinal necrosis treated non-surgically\",\"authors\":\"Haihui Wei, WenJing Xu, Hai Jiang, Siyan Jin, Xiaoli Liu\",\"doi\":\"10.1038/s41433-024-03319-3\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<h3 data-test=\\\"abstract-sub-heading\\\">Objectives</h3><p>To analyse the prognostic factors for visual acuity in acute retinal necrosis (ARN) patients treated non-surgically.</p><h3 data-test=\\\"abstract-sub-heading\\\">Methods</h3><p>The clinical data of ARN patients who visited our hospital from January 2010 to January 2023 were retrospectively analysed.</p><h3 data-test=\\\"abstract-sub-heading\\\">Results</h3><p>Twenty-four patients (29 eyes) were included. Aqueous humour samples were collected from 20 out of 29 eyes, and PCR confirmed that 85% (17/20) of the eyes had VZV infection, 10% (2/20) had CMV infection, and 5% (1/20) had HSV infection. All patients were treated with intravenous antiviral agents. Intravitreal ganciclovir and oral corticosteroids were given according to the patients’ wishes. A comparison of visual acuity at the time of first identification of inactive ARN with that at the first visit revealed that 16 (55.2%) eyes improved and 13 (44.8%) did not improve. Logistic regression analysis revealed that risk factors for failure to improve vision after treatment included retinal detachment (odds ratio [OR],33.75; 95% CI, 3.245–351.067; <i>P</i> = 0.003), necrotising retinitis involving the posterior pole (odds ratio [OR],8.167; 95% CI, 1.297–51.403, <i>P</i> = 0.025), and arteritis involving the large retinal arteries (odds ratio [OR],9.167; 95% CI, 1.493–56.297; <i>P</i> = 0.017). The VZV viral load in the aqueous humour at initial presentation was significantly associated with visual prognosis (<i>r</i> = 0.688, <i>P</i> = 0.013), retinal detachment (<i>τ</i> = 0.597, <i>P</i> = 0.021) and the extent of retinal necrosis (<i>τ</i> = 0.57, <i>P</i> = 0.027). The neutrophil to lymphocyte ratio (NLR) of VZV-infected patients at first presentation was significantly correlated with the prognosis of visual acuity (<i>r</i> = 0.616, <i>P</i> = 0.033) and retinal detachment (<i>τ</i> = 0.728, <i>P</i> = 0.004).</p><h3 data-test=\\\"abstract-sub-heading\\\">Conclusions</h3><p>High NLR and viral DNA copy number in the aqueous humour at the initial presentation, as well as subsequent retinal detachment, necrotising retinitis involving the posterior pole, and arteritis involving the large retinal arteries were risk factors for poor visual prognosis in VZV-infected ARN patients.</p>\",\"PeriodicalId\":12125,\"journal\":{\"name\":\"Eye\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2024-09-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Eye\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1038/s41433-024-03319-3\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OPHTHALMOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Eye","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1038/s41433-024-03319-3","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
Prognostic factors associated with acute retinal necrosis treated non-surgically
Objectives
To analyse the prognostic factors for visual acuity in acute retinal necrosis (ARN) patients treated non-surgically.
Methods
The clinical data of ARN patients who visited our hospital from January 2010 to January 2023 were retrospectively analysed.
Results
Twenty-four patients (29 eyes) were included. Aqueous humour samples were collected from 20 out of 29 eyes, and PCR confirmed that 85% (17/20) of the eyes had VZV infection, 10% (2/20) had CMV infection, and 5% (1/20) had HSV infection. All patients were treated with intravenous antiviral agents. Intravitreal ganciclovir and oral corticosteroids were given according to the patients’ wishes. A comparison of visual acuity at the time of first identification of inactive ARN with that at the first visit revealed that 16 (55.2%) eyes improved and 13 (44.8%) did not improve. Logistic regression analysis revealed that risk factors for failure to improve vision after treatment included retinal detachment (odds ratio [OR],33.75; 95% CI, 3.245–351.067; P = 0.003), necrotising retinitis involving the posterior pole (odds ratio [OR],8.167; 95% CI, 1.297–51.403, P = 0.025), and arteritis involving the large retinal arteries (odds ratio [OR],9.167; 95% CI, 1.493–56.297; P = 0.017). The VZV viral load in the aqueous humour at initial presentation was significantly associated with visual prognosis (r = 0.688, P = 0.013), retinal detachment (τ = 0.597, P = 0.021) and the extent of retinal necrosis (τ = 0.57, P = 0.027). The neutrophil to lymphocyte ratio (NLR) of VZV-infected patients at first presentation was significantly correlated with the prognosis of visual acuity (r = 0.616, P = 0.033) and retinal detachment (τ = 0.728, P = 0.004).
Conclusions
High NLR and viral DNA copy number in the aqueous humour at the initial presentation, as well as subsequent retinal detachment, necrotising retinitis involving the posterior pole, and arteritis involving the large retinal arteries were risk factors for poor visual prognosis in VZV-infected ARN patients.
期刊介绍:
Eye seeks to provide the international practising ophthalmologist with high quality articles, of academic rigour, on the latest global clinical and laboratory based research. Its core aim is to advance the science and practice of ophthalmology with the latest clinical- and scientific-based research. Whilst principally aimed at the practising clinician, the journal contains material of interest to a wider readership including optometrists, orthoptists, other health care professionals and research workers in all aspects of the field of visual science worldwide. Eye is the official journal of The Royal College of Ophthalmologists.
Eye encourages the submission of original articles covering all aspects of ophthalmology including: external eye disease; oculo-plastic surgery; orbital and lacrimal disease; ocular surface and corneal disorders; paediatric ophthalmology and strabismus; glaucoma; medical and surgical retina; neuro-ophthalmology; cataract and refractive surgery; ocular oncology; ophthalmic pathology; ophthalmic genetics.