Polymerase chain reaction analysis of aqueous humour samples in necrotising retinitis

Abstract

Aim: To evaluate the diagnostic value of polymerase chain reaction (PCR) performed on aqueous humour for the detection of viral DNA in patients with necrotising herpetic retinitis.

Methods: The clinical features and laboratory results of 22 patients (29 eyes) presenting with necrotising herpetic retinitis between March 1999 and June 2001 were reviewed retrospectively. Aqueous humour was obtained after anterior chamber paracentesis and PCR was performed in all cases.

Results: Viral DNA was detected in the aqueous humour of 19 patients (86.4%). Epstein-Barr virus (EBV) seroconversion was evidenced in one additional patient. In the acute retinal necrosis (ARN) group (n = 19), varicella zoster virus (VZV) DNA was identified in six patients, herpes simplex virus 1 (HSV-1) DNA in two patients, herpes simplex virus 2 (HSV-2) DNA in four patients, and cytomegalovirus (CMV) genome in four patients. In the progressive outer retinal necrosis (PORN) group (n = 3), VZV DNA was detected in all patients. No sample was positive for more than one virus.

Conclusions: PCR analysis of aqueous humour in patients with clinical features of necrotising viral retinitis can provide specific aetiological orientation and the method appears to be safe and highly sensitive.

Figure 1

(Top left) Fundus photograph of patient 15. Vasculitis, retinal necrosis, and haemorrhages due to CMV in a HAART (highly active antiretroviral therapy), responder patient. (Top right) Peripheral retinal necrosis in patient 19. (Bottom left) Papillitis and diffuse arteritis due to HSV-1 in patient 1. (Bottom right) ARN syndrome with multiple necrotic satellite foci associated with haemorrhages.