Herpes Simplex Virus-2-Associated Retinal Vasculitis Without Clinically Evident Necrosis: Expanding the Spectrum of...

We report a rare case of acute retinal vasculitis without clinically evident retinal necrosis secondary to herpes simplex virus-2 (HSV-2) in an immunocompetent patient presenting two weeks after uneventful cataract surgery. A preoperative dilated fundus examination confirmed a normal posterior pole without vasculitis or retinal pathology. Postoperatively, the patient developed sudden diminution of vision, hypertensive uveitis with markedly elevated intraocular pressure (44 mmHg), dense vitritis, and extensive occlusive vasculitis without clinically apparent retinal necrosis. Aqueous humor PCR confirmed HSV-2 infection, and prompt initiation of antiviral therapy resulted in significant clinical improvement. While the temporal association with cataract surgery raises the possibility of surgical stress as a trigger for viral reactivation, this remains a hypothesis that cannot be substantiated by a single case. Furthermore, although no frank necrosis was observed, subtle changes could not be excluded, and the condition may therefore be better considered within the spectrum of herpetic retinitis rather than isolated vasculitis. This case emphasizes the need to consider viral etiologies in postoperative uveitis and retinal vasculitis, even in immunocompetent hosts.