{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T11:45:08Z","timestamp":1774957508258,"version":"3.50.1"},"reference-count":36,"publisher":"BMJ","issue":"1","funder":[{"DOI":"10.13039\/501100018609","name":"Guangdong Province High-level Hospital Construction Project","doi-asserted-by":"crossref","award":["303010401"],"award-info":[{"award-number":["303010401"]}],"id":[{"id":"10.13039\/501100018609","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82171091"],"award-info":[{"award-number":["82171091"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2024,6,2]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Progressive outer retinal necrosis (PORN) is an alphaherpesvirus-caused panuveitis with devastating consequences for the eye. Our study aims to describe new findings in the clinical spectrum and propose a mechanism for the pathogenesis of PORN.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Observational, consecutive case series. Seven eyes from five patients diagnosed with PORN were enrolled. Detailed case histories, ocular examination findings and multimodal images of retina were collected. Optic nerve and brain imaging were obtained by MRI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All eyes were confirmed human alphaherpesviruses positive in ocular fluid by qPCR. Optic nerve oedema was observed on MRI in all eyes. A relative afferent pupillary defect was recorded in the affected eye for the unilateral cases. Two patients with unilateral involvement had a history of viral encephalitis and focal encephalomalacia found in the temporal lobe on brain MRI. The affected eyes were characterised by sensory retinal necrosis sparing retinal pigment epithelium, starting at the end of the retinal nerve fibre (horizontal raphe or peripheral area of the retina) and progressing rapidly along the nerve fibre. The wall of the retinal artery and vein was destroyed, resulting in blood flow interruption on fluorescein angiography and retinal haemorrhages along the large vessels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Combination the neurotropic characteristics of alphaherpesviruses and the signs of PORN, we hypothesised that the reactivated PORN virus originated from the lateral geniculate nucleus, then propagated along the optic nerve and was released at the terminals, causing necrosis of the entire sensory retina rather than just affecting the outer segment.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bjo-2023-325113","type":"journal-article","created":{"date-parts":[[2024,9,5]],"date-time":"2024-09-05T09:43:53Z","timestamp":1725529433000},"page":"107-112","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Clinical spectrum and possible pathogenesis of progressive outer retinal necrosis"],"prefix":"10.1136","volume":"109","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3385-6572","authenticated-orcid":false,"given":"Xiaohu","family":"Ding","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert T","family":"Chang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5530-4202","authenticated-orcid":false,"given":"Xiongze","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"LiLi","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yangfan","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lin","family":"Lu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4596-2196","authenticated-orcid":false,"given":"Xiaofeng","family":"Lin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,9,5]]},"reference":[{"key":"2025040105502538000_109.1.107.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9394(14)77012-6"},{"key":"2025040105502538000_109.1.107.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9394(14)76690-5"},{"key":"2025040105502538000_109.1.107.3","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1016\/S0002-9394(14)70020-0","article-title":"Varicella-zoster virus retinitis as the initial manifestation of the acquired immunodeficiency syndrome","volume":"117","author":"Friedman","year":"1994","journal-title":"Am J Ophthalmol"},{"key":"2025040105502538000_109.1.107.4","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/S0002-9394(14)76574-2","article-title":"Clinical and histopathologic study of varicella zoster virus retinitis in patients with the acquired immunodeficiency syndrome","volume":"118","author":"Kuppermann","year":"1994","journal-title":"Am J Ophthalmol"},{"key":"2025040105502538000_109.1.107.5","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1038\/eye.1995.53","article-title":"Progressive outer retinal necrosis (PORN) in AIDS patients: a different appearance of varicella-zoster retinitis","volume":"9 (Pt 3)","author":"Pavesio","year":"1995","journal-title":"Eye (Lond)"},{"key":"2025040105502538000_109.1.107.6","doi-asserted-by":"crossref","first-page":"506","DOI":"10.3928\/15428877-20061101-13","article-title":"Optical coherence tomography in progressive outer retinal necrosis","volume":"37","author":"Narayanan","year":"2006","journal-title":"Ophthalmic Surg Lasers Imaging"},{"key":"2025040105502538000_109.1.107.7","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1097\/IAE.0b013e3180cc2630","article-title":"Optical coherence tomography of progressive outer retinal necrosis","volume":"27","author":"Blair","year":"2007","journal-title":"Retina"},{"key":"2025040105502538000_109.1.107.8","first-page":"1","article-title":"Fundus Autofluorescence and OCT in the Management of Progressive Outer Retinal Necrosis","volume":"2010","author":"Yeh","year":"2010","journal-title":"Ophthalmic Surg Lasers Imaging"},{"key":"2025040105502538000_109.1.107.9","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1001\/jamaophthalmol.2014.120","article-title":"Progressive outer retinal necrosis (PORN): a catchy acronym but is the anatomy correct? 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