[Varicella zoster virus infections of the retina in patients with and without immune suppression].

BACKGROUND

Infections of the retina with the varicella-zoster virus can lead to severe visual impairment. Patients with immunodeficiency are particularly predisposed to viral infections, and the alterations of the immune system may lead to a modified clinical picture.

PATIENTS: Two cases of infections of the retina with the varicella-zoster virus in an immunocompromised and an immunocompetent patient are presented. The first otherwise healthy patient showed the typical clinical picture of the "acute retinal necrosis syndrome" with orbital pain and decrease of vision. He had inflammatory infiltration of the vitreous and the anterior chamber, retinal vasculitis, optic disc edema and whitening of the peripheral retina with full thickness retinal necrosis. The second patient with AIDS presented with a history of sudden painless loss of vision in one eye. He had a swollen optic disc, inflammatory infiltrates in the choroid and virtually no cellular infiltration of the vitreous or the anterior chamber. The diagnosis of varicella-zoster virus infection of the retina was confirmed in both patients by polymerase chain-reaction of aqueous and vitreous humor, by determination of intraocular antibody titers and immunohistochemistry on retinal biopsy material, respectively. In both patients no inflammation in the fellow eye developed under therapy with aciclovir. The first patient regained full vision after vitrectomy with membrane dissection.

CONCLUSIONS

Varicella-zoster virus infections of the retina can present with different clinical pictures in immunocompromised and immunocompetent patients. Early diagnosis and adequate medical and surgical therapy can significantly improve visual prognosis.