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Saving Vision in a Child With Light Perception Vision Due to Acute Retinal Necrosis Secondary to Herpes Simplex Virus
Ngan-Ha Nguyen1,2, Peter McCluskey3, Minh-Phu Nguyen4
1The Department of Ophthalmology, Hanoi Medical University, Hanoi, Vietnam.
Insights
Acute retinal necrosis (ARN) can rapidly develop in children after herpes simplex encephalitis (HSE), even with antiviral treatment. Early medical and surgical intervention is crucial for preserving vision in these complex pediatric cases.
Area of Science:
- Ophthalmology
- Virology
- Pediatric Neurology
Background:
- Herpes simplex virus (HSV) infections can impact the central nervous system and eyes, causing conditions like herpes simplex encephalitis (HSE) and acute retinal necrosis (ARN).
- ARN is a severe ocular condition that can lead to vision loss, and its occurrence following HSE, even with treatment, is a significant clinical concern.
Purpose of the Study:
- To report a case of a pediatric patient who developed ARN after HSE despite systemic antiviral therapy.
- To highlight the importance of ophthalmic monitoring in HSE patients and the efficacy of combined medical and surgical management for ARN.
Main Methods:
- A 13-year-old boy with confirmed HSE developed ARN in his left eye.
- Diagnosis of ARN was confirmed by HSV-1 detection in vitreous fluid via PCR.
- Treatment involved intravitreal antivirals, pars plana vitrectomy with silicone oil tamponade, laser retinopexy, cataract extraction, and silicone oil removal.
Main Results:
- The patient presented with vision loss (light perception), vitritis, retinal necrosis, and detachment.
- Following treatment, retinal reattachment was achieved, with visual acuity improving from light perception to 20/200, and further to 20/80 after subsequent procedures.
- The case demonstrates the potential for visual recovery despite severe ocular complications.
Conclusions:
- Ocular complications like ARN can manifest rapidly in children recovering from HSE, necessitating vigilant ophthalmic surveillance.
- Early and aggressive combined medical and surgical interventions can lead to favorable visual outcomes in pediatric ARN with retinal detachment.
- This case contributes to the understanding of HSE-ARN linkage in children and emphasizes timely management for preserving vision.
Abstract:
Herpes simplex virus (HSV) can affect both the central nervous system and the eye, most notably as herpes simplex encephalitis and the less common but vision-threatening acute retinal necrosis (ARN). The authors report a 13-year-old boy who developed ARN shortly after confirmed herpes simplex encephalitis despite appropriate systemic antiviral therapy. He presented with light perception vision, vitritis, retinal necrosis, and retinal detachment in the left eye, with HSV-1 detected by polymerase chain reaction from vitreous fluid. Intravitreal antiviral therapy was promptly administered, followed by early pars plana vitrectomy with silicone oil tamponade and 360-degree peripheral retinal laser, resulting in retinal reattachment and improvement of visual acuity to 20/200. After subsequent cataract extraction and silicone oil removal, visual acuity further improved to 20/80. This case emphasizes the importance of close ophthalmic monitoring in patients recovering from herpes simplex encephalitis, because ocular disease may develop rapidly even under systemic antivirals. It also underscores that early combined medical and surgical intervention can preserve meaningful vision in pediatric ARN complicated by retinal detachment. Such reports contribute to the limited literature linking herpes simplex encephalitis and ARN in children and highlight the potential for favorable outcomes with timely management.
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