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77-year-old woman was seen in the office on 4/15/2011. I appreciate you contacting me about her history. She had shingles on the left side of her face about the end of February. She had some blisters. She felt it around her hair and then her left eyelid and then she developed a dendrite in the cornea which you started treating about four weeks ago. She noticed severe vision loss in the left eye just a few days ago and you saw retinitis and she comes in because of that. She is currently on FML drops in the left eye. Her vision in the right eye is good and has been unaffected. She has not noticed any floaters or vision change. She does have chronic lymphocytic leukemia and she does run a little bit anemic and has had transfusions in the past, although not lately. She has a history of high blood pressure as well. She is on Acyclovir in the right eye 800 mg five times a day. She just started that yesterday. VISUAL ACUITY: Vision OD is 20/25, OS is hand motion. IOP: OD 16, OS 24. SLIT LAMP EXAM: The right eye has a posterior chamber intraocular lens in good position with 2+ posterior capsular opacity. The left eye has 1+ cell and flare of the anterior chamber. The posterior chamber intraocular lens is in good position. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.5. There is a posterior vitreous separation. There is a flame hemorrhage superior to the macula, which looks to probably be from the anemia. There is no sign of retinitis or vasculitis nor is there vitritis. OS: Vertical C/D ratio is 0.5. The retina is white all surrounding the optic nerve 360° and from the macula out to the periphery. PHOTOGRAPHS: Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: FA done of the left eye shows good circulation with good filling of the retinal vessels and recirculation time. The right eye is angiographically normal. IMPRESSION: 1. Progressive Outer Retinal Necrosis (ACUTE RETINAL NECROSIS) – LEFT EYE DISCUSSION: I explained to the patient unfortunately she has progressive outer retinal necrosis and given the history, it is likely herpes zoster related. She is currently taking Acyclovir. I am switching her just for the time being to Valacyclovir 2000 mg three times daily for two weeks ,and then after that we can maintain her on a maintenance therapy to protect the fellow eye, probably for six to twelve month, with either Valacyclovir 1000 mg twice a day or Acyclovir three times a day. I told her to keep the Acyclovir she has and to fill the Valacyclovir prescription today and start it. There is a high risk of retinal detachment in the eye, but given the configuration of the retina, unfortunately the visual prognosis for this eye is limited and, in all likelihood, she will lose light perception in the eye within the next few weeks. Unfortunately, the eyes that are infected with the herpes virus do not survive, and in her case, there is a 360° infection around the optic nerve and also the entire macula is involved. Her risk of retinal detachment is high as well, but that can be managed conservatively given the limited visual prognosis. There is recent evidence that laser treatment is probably not helpful in this situation.

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Progressive Outer Retinal Necrosis 77 Year Old Woman with CLL (Acute Retinal Necrosis) (PORN - ARN)586 views77-year-old woman with CLL who had shingles on the left side of her face about 6 weeks ago then she developed a dendrite in the cornea which was treating about four weeks ago. She noticed severe vision loss in the left eye just a few days ago and you saw retinitis and she comes in because of that. Vision OD is 20/25, OS is hand motion00000
(0 votes)
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Progressive Outer Retinal Necrosis 77 Year Old Woman with CLL (Acute Retinal Necrosis) (PORN - ARN)601 views77-year-old woman with CLL who had shingles on the left side of her face about 6 weeks ago then she developed a dendrite in the cornea which was treating about four weeks ago. She noticed severe vision loss in the left eye just a few days ago and you saw retinitis and she comes in because of that. Vision OD is 20/25, OS is hand motion00000
(0 votes)
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Progressive Outer Retinal Necrosis 77 Year Old Woman with CLL (Acute Retinal Necrosis) (PORN - ARN)477 views77-year-old woman with CLL who had shingles on the left side of her face about 6 weeks ago then she developed a dendrite in the cornea which was treating about four weeks ago. She noticed severe vision loss in the left eye just a few days ago and you saw retinitis and she comes in because of that. Vision OD is 20/25, OS is hand motion55555
(1 votes)
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Progressive Outer Retinal Necrosis 77 Year Old Woman with CLL (Acute Retinal Necrosis) (PORN - ARN)847 views77-year-old woman with CLL who had shingles on the left side of her face about 6 weeks ago then she developed a dendrite in the cornea which was treating about four weeks ago. She noticed severe vision loss in the left eye just a few days ago and you saw retinitis and she comes in because of that. Vision OD is 20/25, OS is hand motion00000
(0 votes)
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Progressive Outer Retinal Necrosis 77 Year Old Woman with CLL (Acute Retinal Necrosis) (PORN - ARN)384 views77-year-old woman with CLL who had shingles on the left side of her face about 6 weeks ago then she developed a dendrite in the cornea which was treating about four weeks ago. She noticed severe vision loss in the left eye just a few days ago and you saw retinitis and she comes in because of that. Vision OD is 20/25, OS is hand motion00000
(0 votes)
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Progressive Outer Retinal Necrosis 77 Year Old Woman with CLL (Acute Retinal Necrosis) (PORN - ARN)481 views77-year-old woman with CLL who had shingles on the left side of her face about 6 weeks ago then she developed a dendrite in the cornea which was treating about four weeks ago. She noticed severe vision loss in the left eye just a few days ago and you saw retinitis and she comes in because of that. Vision OD is 20/25, OS is hand motion00000
(0 votes)
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Progressive Outer Retinal Necrosis 77 Year Old Woman with CLL (Acute Retinal Necrosis) (PORN - ARN)242 views77-year-old woman with CLL who had shingles on the left side of her face about 6 weeks ago then she developed a dendrite in the cornea which was treating about four weeks ago. She noticed severe vision loss in the left eye just a few days ago and you saw retinitis and she comes in because of that. Vision OD is 20/25, OS is hand motion00000
(0 votes)
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Progressive Outer Retinal Necrosis 77 Year Old Woman with CLL (Acute Retinal Necrosis) (PORN - ARN)314 views77-year-old woman with CLL who had shingles on the left side of her face about 6 weeks ago then she developed a dendrite in the cornea which was treating about four weeks ago. She noticed severe vision loss in the left eye just a few days ago and you saw retinitis and she comes in because of that. Vision OD is 20/25, OS is hand motion00000
(0 votes)
arn_shha09.jpg
Progressive Outer Retinal Necrosis 77 Year Old Woman with CLL (Acute Retinal Necrosis) (PORN - ARN)233 views77-year-old woman with CLL who had shingles on the left side of her face about 6 weeks ago then she developed a dendrite in the cornea which was treating about four weeks ago. She noticed severe vision loss in the left eye just a few days ago and you saw retinitis and she comes in because of that. Vision OD is 20/25, OS is hand motion00000
(0 votes)
arn_shha10.jpg
Progressive Outer Retinal Necrosis 77 Year Old Woman with CLL (Acute Retinal Necrosis) (PORN - ARN)204 views77-year-old woman with CLL who had shingles on the left side of her face about 6 weeks ago then she developed a dendrite in the cornea which was treating about four weeks ago. She noticed severe vision loss in the left eye just a few days ago and you saw retinitis and she comes in because of that. Vision OD is 20/25, OS is hand motion00000
(0 votes)
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Progressive Outer Retinal Necrosis 77 Year Old Woman with CLL (Acute Retinal Necrosis) (PORN - ARN)200 views77-year-old woman with CLL who had shingles on the left side of her face about 6 weeks ago then she developed a dendrite in the cornea which was treating about four weeks ago. She noticed severe vision loss in the left eye just a few days ago and you saw retinitis and she comes in because of that. Vision OD is 20/25, OS is hand motion00000
(0 votes)
arn_shha12.jpg
Progressive Outer Retinal Necrosis 77 Year Old Woman with CLL (Acute Retinal Necrosis) (PORN - ARN)250 views77-year-old woman with CLL who had shingles on the left side of her face about 6 weeks ago then she developed a dendrite in the cornea which was treating about four weeks ago. She noticed severe vision loss in the left eye just a few days ago and you saw retinitis and she comes in because of that. Vision OD is 20/25, OS is hand motion00000
(0 votes)
arn_shha13.jpg
Progressive Outer Retinal Necrosis 77 Year Old Woman with CLL (Acute Retinal Necrosis) (PORN - ARN)183 views77-year-old woman with CLL who had shingles on the left side of her face about 6 weeks ago then she developed a dendrite in the cornea which was treating about four weeks ago. She noticed severe vision loss in the left eye just a few days ago and you saw retinitis and she comes in because of that. Vision OD is 20/25, OS is hand motion00000
(0 votes)
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Progressive Outer Retinal Necrosis 77 Year Old Woman with CLL (Acute Retinal Necrosis) (PORN - ARN)202 views77-year-old woman with CLL who had shingles on the left side of her face about 6 weeks ago then she developed a dendrite in the cornea which was treating about four weeks ago. She noticed severe vision loss in the left eye just a few days ago and you saw retinitis and she comes in because of that. Vision OD is 20/25, OS is hand motion00000
(0 votes)
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Progressive Outer Retinal Necrosis 77 Year Old Woman with CLL (Acute Retinal Necrosis) (PORN - ARN)195 views77-year-old woman with CLL who had shingles on the left side of her face about 6 weeks ago then she developed a dendrite in the cornea which was treating about four weeks ago. She noticed severe vision loss in the left eye just a few days ago and you saw retinitis and she comes in because of that. Vision OD is 20/25, OS is hand motion44444
(1 votes)
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Progressive Outer Retinal Necrosis 77 Year Old Woman with CLL (Acute Retinal Necrosis) (PORN - ARN)140 views77-year-old woman with CLL who had shingles on the left side of her face about 6 weeks ago then she developed a dendrite in the cornea which was treating about four weeks ago. She noticed severe vision loss in the left eye just a few days ago and you saw retinitis and she comes in because of that. Vision OD is 20/25, OS is hand motion00000
(0 votes)
arn_shha17.jpg
Progressive Outer Retinal Necrosis 77 Year Old Woman with CLL (Acute Retinal Necrosis) (PORN - ARN)189 views77-year-old woman with CLL who had shingles on the left side of her face about 6 weeks ago then she developed a dendrite in the cornea which was treating about four weeks ago. She noticed severe vision loss in the left eye just a few days ago and you saw retinitis and she comes in because of that. Vision OD is 20/25, OS is hand motion00000
(0 votes)
arn_shha18.jpg
Progressive Outer Retinal Necrosis 77 Year Old Woman with CLL (Acute Retinal Necrosis) (PORN - ARN)172 views77-year-old woman with CLL who had shingles on the left side of her face about 6 weeks ago then she developed a dendrite in the cornea which was treating about four weeks ago. She noticed severe vision loss in the left eye just a few days ago and you saw retinitis and she comes in because of that. Vision OD is 20/25, OS is hand motion00000
(0 votes)
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Progressive Outer Retinal Necrosis 77 Year Old Woman with CLL (Acute Retinal Necrosis) (PORN - ARN)191 views77-year-old woman with CLL who had shingles on the left side of her face about 6 weeks ago then she developed a dendrite in the cornea which was treating about four weeks ago. She noticed severe vision loss in the left eye just a few days ago and you saw retinitis and she comes in because of that. Vision OD is 20/25, OS is hand motion00000
(0 votes)
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Progressive Outer Retinal Necrosis 77 Year Old Woman with CLL (Acute Retinal Necrosis) (PORN - ARN)149 views77-year-old woman with CLL who had shingles on the left side of her face about 6 weeks ago then she developed a dendrite in the cornea which was treating about four weeks ago. She noticed severe vision loss in the left eye just a few days ago and you saw retinitis and she comes in because of that. Vision OD is 20/25, OS is hand motion00000
(0 votes)
arn_shha21.jpg
Progressive Outer Retinal Necrosis 77 Year Old Woman with CLL (Acute Retinal Necrosis) (PORN - ARN)125 views77-year-old woman with CLL who had shingles on the left side of her face about 6 weeks ago then she developed a dendrite in the cornea which was treating about four weeks ago. She noticed severe vision loss in the left eye just a few days ago and you saw retinitis and she comes in because of that. Vision OD is 20/25, OS is hand motion00000
(0 votes)
arn_shha22.jpg
Progressive Outer Retinal Necrosis 77 Year Old Woman with CLL (Acute Retinal Necrosis) (PORN - ARN)251 views77-year-old woman with CLL who had shingles on the left side of her face about 6 weeks ago then she developed a dendrite in the cornea which was treating about four weeks ago. She noticed severe vision loss in the left eye just a few days ago and you saw retinitis and she comes in because of that. Vision OD is 20/25, OS is hand motion00000
(0 votes)
arn_shha23.jpg
Progressive Outer Retinal Necrosis 77 Year Old Woman with CLL (Acute Retinal Necrosis) (PORN - ARN)244 views77-year-old woman with CLL who had shingles on the left side of her face about 6 weeks ago then she developed a dendrite in the cornea which was treating about four weeks ago. She noticed severe vision loss in the left eye just a few days ago and you saw retinitis and she comes in because of that. Vision OD is 20/25, OS is hand motion00000
(0 votes)
arn_shha24.jpg
Progressive Outer Retinal Necrosis 77 Year Old Woman with CLL (Acute Retinal Necrosis) (PORN - ARN)278 views77-year-old woman with CLL who had shingles on the left side of her face about 6 weeks ago then she developed a dendrite in the cornea which was treating about four weeks ago. She noticed severe vision loss in the left eye just a few days ago and you saw retinitis and she comes in because of that. Vision OD is 20/25, OS is hand motion00000
(0 votes)
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77-year-old woman was seen in the office on 4/15/2011. I appreciate you contacting me about her history. She had shingles on the left side of her face about the end of February. She had some blisters. She felt it around her hair and then her left eyelid and then she developed a dendrite in the cornea which you started treating about four weeks ago. She noticed severe vision loss in the left eye just a few days ago and you saw retinitis and she comes in because of that. She is currently on FML drops in the left eye. Her vision in the right eye is good and has been unaffected. She has not noticed any floaters or vision change. She does have chronic lymphocytic leukemia and she does run a little bit anemic and has had transfusions in the past, although not lately. She has a history of high blood pressure as well. She is on Acyclovir in the right eye 800 mg five times a day. She just started that yesterday. VISUAL ACUITY: Vision OD is 20/25, OS is hand motion. IOP: OD 16, OS 24. SLIT LAMP EXAM: The right eye has a posterior chamber intraocular lens in good position with 2+ posterior capsular opacity. The left eye has 1+ cell and flare of the anterior chamber. The posterior chamber intraocular lens is in good position. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.5. There is a posterior vitreous separation. There is a flame hemorrhage superior to the macula, which looks to probably be from the anemia. There is no sign of retinitis or vasculitis nor is there vitritis. OS: Vertical C/D ratio is 0.5. The retina is white all surrounding the optic nerve 360° and from the macula out to the periphery. PHOTOGRAPHS: Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: FA done of the left eye shows good circulation with good filling of the retinal vessels and recirculation time. The right eye is angiographically normal. IMPRESSION: 1. Progressive Outer Retinal Necrosis (ACUTE RETINAL NECROSIS) – LEFT EYE DISCUSSION: I explained to the patient unfortunately she has progressive outer retinal necrosis and given the history, it is likely herpes zoster related. She is currently taking Acyclovir. I am switching her just for the time being to Valacyclovir 2000 mg three times daily for two weeks ,and then after that we can maintain her on a maintenance therapy to protect the fellow eye, probably for six to twelve month, with either Valacyclovir 1000 mg twice a day or Acyclovir three times a day. I told her to keep the Acyclovir she has and to fill the Valacyclovir prescription today and start it. There is a high risk of retinal detachment in the eye, but given the configuration of the retina, unfortunately the visual prognosis for this eye is limited and, in all likelihood, she will lose light perception in the eye within the next few weeks. Unfortunately, the eyes that are infected with the herpes virus do not survive, and in her case, there is a 360° infection around the optic nerve and also the entire macula is involved. Her risk of retinal detachment is high as well, but that can be managed conservatively given the limited visual prognosis. There is recent evidence that laser treatment is probably not helpful in this situation.