Necrotizing and Nonnecrotizing Variants of Herpetic Uveitis With Posterior Segment Involvement

Objective: To describe the clinical characteristics and prognosis of diverse variants of herpetic uveitis with posterior segment involvement. Methods/Design: Retrospective observational study of clinical, imaging, and laboratory data. Results: Twenty-five patients were classified as having typical acute retinal necrosis (ARN) and 13 patients as not having ARN (non-ARN). Age at symptom onset, sex, bilateral involvement, and prevalence of viral species were not significantly different between patients in the ARN and non-ARN groups. All patients in the ARN group had necrotic retinal lesions that progressed quickly, whereas only 4 of 13 patients (31%) in the non-ARN group (P<.001) had necrotic retinal lesions that progressed slowly. Necrotizing variants were noted in 29 of 38 patients (76%), including 4 patients with slowly progressing lesions. Nine remaining patients in the non-ARN group had nonnecrotizing posterior uveitis without retinal lesions; their cases were characterized by vitritis, vasculitis, and/or papillitis, or as panuveitis without any distinct features (5 patients [38.5%]). At 6 months' follow-up, visual acuity of less than 0.1 developed in 13 of 25 patients (52%) in the ARN group and in 4 of 13 patients (31%) in the non-ARN group (P=.30). Conclusions: Herpes simplex and varicella zoster viruses can cause a wide spectrum of clinical manifestations ranging from severe ARN to slow-progressing necrotizing and nonnecrotizing types of inflammation. The non-ARN variants are currently underdiagnosed. Patients with these variants could potentially benefit from earlier recognition and treatment.