Clinical Features, Management and Outcomes of Progressive Outer Retinal Necrosis (PORN) in Southern Thailand
Wantanee Sittivarakul MD*, Nipat Aui-aree MD*
Affiliation : * Department of Ophthalmology, Songklanagarind Hospital, Prince of Songkla University, Hat Yai, Songkhla, Thailand
Objective : To study the demographics, clinical features, treatment, and visual outcomes of progressive outer
retinal necrosis (PORN) in a group of Thai patients.
Material and Method: All cases of AIDS with a clinical diagnosis of PORN in a major tertiary referral hospital
in southern Thailand between January 2003 and June 2007 were retrospectively reviewed. Demographic
data, clinical features, treatment regimens, and visual outcomes were analyzed.
Results : Seven patients (11 eyes) were studied. The mean age was 44.7 years. The median CD4 count was 12
cells/mm3. A known history of cutaneous zoster was documented in 57% of cases. The median follow-up period
was 17 weeks. Fifty-seven percent of the patients had bilateral disease. A majority of eyes (45.4%) had initial
visual acuity of less than 20/50 to equal to or better than 20/200. About two-thirds of the eyes had anterior
chamber cells. Vitritis and retinal lesions scattered throughout both posterior pole and peripheral retina
were found in 72.7%. Either intravenous acyclovir in combination with intravitreal ganciclovir injections or
intravenous aclyclovir alone was used for initial treatment. Retinal detachment occurred in 54.5%. Final
visual acuity worsened (loss of 3 lines on the ETDRS chart or more) in 60%. Visual acuity was no light
perception in 45.5% at the final recorded follow-up.
Conclusion : Demographics, clinical features and treatment outcomes of PORN in this group of Thai patients
were comparable with studies from other countries. Visual prognosis is still poor with current treatment
regimens.
Keywords : AIDS-Related opportunistic infections, Acquired immunodeficiency syndrome, Herpesvirus 3, Human, Retinal necrosis syndrome, Acute
