Etiologic distribution of necrotizing retinopathies : a nine‐year experience at a university referral centre

Purpose To assess the etiologic distribution of necrotizing retinopathies based on an extensive work‐up including molecular tools applied to ocular fluids Methods All patients referred for the diagnostic and therapeutic management of an atypical posterior or panuveitis underwent an extensive work‐up to exclude an infectious condition. All patients underwent anterior chamber paracentesis or vitrectomy for diagnostic purposes. PCR and cytology were performed in order to confirm an infectious entity or a masquerade syndrome Results The clinical findings of 218 patients were analyzed in this retrospective study. The sex‐ratio (M/F) was 1.44 including 129 men and 89 women. The mean age was 46.6 years (range from 7 To 90 yo). A viral infection was confirmed in 146 cases (67,5%). Viral distribution determined 55 CMV retinitis, 48 VZV retinitis, 34 HSV 1 or 2 retinitis and 9 EBV panuveitis. Nonviral causes of infectious or inflammatory retinopathies were determined in 66 cases, masquerading as a viral retinopathy. Most of the cases were due to a parasitic infection (59%) followed by a primary intraocular lymphoma (12,1%), a bacterial uveitis (7,5%), Behçet’s disease (7,5%), endogenous endophthalmitis (3%), sarcoidosis (1,5%) and others (9,4%). Six cases remained idiopathic Conclusion All patients with an atypical retinopathy and a suspicion of infectious etiology deserve an extensive work‐up, including ocular fluid analysis. The yield of PCR technology remains excellent for viral retinopathies. Even though most of the cases are viral‐induced, other entities may present with similar clinical findings. Therefore, prompt diagnosis remains the best strategy to avoid further sight and rarely life‐threatening complications