{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T23:04:16Z","timestamp":1784934256798,"version":"3.55.0"},"reference-count":30,"publisher":"BMJ","issue":"1","funder":[{"name":"Vetenskapliga r\u00e5det Halland","award":["HALLAND-724231"],"award-info":[{"award-number":["HALLAND-724231"]}]},{"DOI":"10.13039\/501100009777","name":"Region Halland","doi-asserted-by":"crossref","award":["HALLAND-685521"],"award-info":[{"award-number":["HALLAND-685521"]}],"id":[{"id":"10.13039\/501100009777","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Agreement concerning research and education of doctors, ALF","award":["ALF-GBG-441721"],"award-info":[{"award-number":["ALF-GBG-441721"]}]},{"name":"D&B Dahlins stiftelse"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Ophth"],"accepted":{"date-parts":[[2019,3,7]]},"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To identify all patients tested positive for herpes viruses in intraocular samples between 2007 and 2016 in South-Western Sweden and evaluate which of these met the criteria of acute retinal necrosis (ARN). To compare viral load in intraocular samples and virus type with clinical outcome.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Method and analysis<\/jats:title>\n                  <jats:p>Retrospective case series. Intraocular samples and serum were analysed with quantitative real-time PCR (qPCR) and presence of antibodies (IgG and IgM) were detected by ELISA in serum.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Between 2007 and 2016, 13 patients met the clinical criteria of ARN and were PCR-positive in aqueous or vitreous for herpes simplex virus 1 (HSV1; n=4), herpes simplex virus 2 (HSV2; n=3) and varicella zoster virus (VZV; n=6). None of the patients tested positive for cytomegalovirus (n=13) or Epstein Barr virus (n=2) met the criteria of ARN. All ARN patients had specific serum IgG and three patients exhibited virus DNA in serum. There was no correlation between high viral load and worse visual outcome. However, higher viral loads were seen in samples taken earlier in the disease process. Median age was higher (p=0.049) in VZV-ARN than for HSV-ARN patients (60.5 and 45.4 years, respectively) with a tendency of worse best corrected visual acuity at presentation (1.62 and 0.79 log MAR, respectively; p=0.079).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>ARN is a reactivation of alpha herpes virus and presence of herpes DNA in serum may occur. VZV-ARN are older than HSV-ARN patients. High viral load does not appear to be a predictor of worse visual outcome, but rather indicates earlier sampling.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjophth-2018-000247","type":"journal-article","created":{"date-parts":[[2019,4,9]],"date-time":"2019-04-09T11:00:51Z","timestamp":1554807651000},"page":"e000247","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Alpha herpes virus type and viral load in intraocular fluids in patients with acute retinal necrosis"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9352-8183","authenticated-orcid":false,"given":"Joanna","family":"von Hofsten","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Hallands sjukhus Halmstad, Halmstad, Sweden"},{"name":"Department of Clinical Neuroscience, University of Gothenburg, M\u00f6lndal, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomas","family":"Bergstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Institute of Microbiology, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madeleine","family":"Zetterberg","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, University of Gothenburg, M\u00f6lndal, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,4,9]]},"reference":[{"key":"2025090109414691000_4.1.e000247.1","first-page":"607","article-title":"Unilateral acute uveitis with periarteritis and detachment","volume":"25","author":"Urayama","year":"1971","journal-title":"Jpn J Clin Ophthalmol"},{"key":"2025090109414691000_4.1.e000247.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(82)34638-2"},{"key":"2025090109414691000_4.1.e000247.3","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1001\/jamaophthalmol.2014.266","article-title":"Acute retinal necrosis associated with Epstein-Barr virus: immunohistopathologic confirmation","volume":"132","author":"Schaal","year":"2014","journal-title":"JAMA ophthalmology"},{"key":"2025090109414691000_4.1.e000247.4","doi-asserted-by":"crossref","first-page":"399","DOI":"10.3928\/23258160-20140908-02","article-title":"Combination systemic and intravitreal antiviral therapy in the management of acute retinal necrosis syndrome","volume":"45","author":"Yeh","year":"2014","journal-title":"Ophthalmic Surg Lasers Imaging Retina"},{"key":"2025090109414691000_4.1.e000247.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9394(14)70075-3"},{"key":"2025090109414691000_4.1.e000247.6","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1007\/s10384-014-0362-0","article-title":"Development and validation of new diagnostic criteria for acute retinal necrosis","volume":"59","author":"Takase","year":"2015","journal-title":"Jpn J Ophthalmol"},{"key":"2025090109414691000_4.1.e000247.7","doi-asserted-by":"crossref","unstructured":"Gargouri S , Khochtali S , Zina S , et al . Ocular involvement associated with varicella in adults. J Ophthal Inflamm Infect 2016;6.doi:10.1186\/s12348-016-0117-9","DOI":"10.1186\/s12348-016-0117-9"},{"key":"2025090109414691000_4.1.e000247.8","doi-asserted-by":"crossref","unstructured":"Gupta R , Tyagi M , Balakrishnan D , et al . Acute retinal necrosis (Arn) following chickenpox in a patient of Vogt-Koyanagi-Harada (VKH) syndrome using immunosuppressants. BMJ Case Rep 2018;11.doi:10.1136\/bcr-2018-227290","DOI":"10.1136\/bcr-2018-227290"},{"key":"2025090109414691000_4.1.e000247.9","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1097\/INF.0000000000001641","article-title":"Varicella zoster virus-associated necrotizing retinitis after chickenpox in a 10-year-old female: a case report","volume":"36","author":"Shin","year":"2017","journal-title":"Pediatr Infect Dis J"},{"key":"2025090109414691000_4.1.e000247.10","doi-asserted-by":"crossref","unstructured":"Yu J , Ashworth J , Hughes S , et al . Varicella-zoster virus necrotising retinitis, retinal vasculitis and panuveitis following uncomplicated chickenpox in an immunocompetent child. BMJ Case Reports 2018;91.doi:10.1136\/bcr-2017-223823","DOI":"10.1136\/bcr-2017-223823"},{"key":"2025090109414691000_4.1.e000247.11","doi-asserted-by":"publisher","DOI":"10.1007\/s004170050153"},{"key":"2025090109414691000_4.1.e000247.12","doi-asserted-by":"crossref","first-page":"246","DOI":"10.3109\/09273948.2015.1115081","article-title":"Correlation of clinical outcomes with quantitative polymerase chain reaction DNA copy number in patients with acute retinal necrosis","volume":"25","author":"Calvo","year":"2017","journal-title":"Ocul Immunol Inflamm"},{"key":"2025090109414691000_4.1.e000247.13","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.2007.125773"},{"key":"2025090109414691000_4.1.e000247.14","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.43.5.2058-2064.2005"},{"key":"2025090109414691000_4.1.e000247.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcv.2009.07.014"},{"key":"2025090109414691000_4.1.e000247.16","doi-asserted-by":"publisher","DOI":"10.1128\/CVI.05061-11"},{"key":"2025090109414691000_4.1.e000247.17","doi-asserted-by":"crossref","first-page":"388","DOI":"10.3928\/1081-597X-19970701-16","article-title":"Proper method for calculating average visual acuity","volume":"13","author":"Holladay","year":"1997","journal-title":"J Refract Surg"},{"key":"2025090109414691000_4.1.e000247.18","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(99)00133-5"},{"key":"2025090109414691000_4.1.e000247.19","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9394(99)00316-5"},{"key":"2025090109414691000_4.1.e000247.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2009.03.029"},{"key":"2025090109414691000_4.1.e000247.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2006.08.037"},{"key":"2025090109414691000_4.1.e000247.22","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9394(14)70631-2"},{"key":"2025090109414691000_4.1.e000247.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2005.09.017"},{"key":"2025090109414691000_4.1.e000247.24","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/S1386-6532(03)00162-8","article-title":"Monitoring herpesviruses DNA in three cases of acute retinal necrosis by real-time PCR","volume":"29","author":"Asano","year":"2004","journal-title":"J Clin Virol"},{"key":"2025090109414691000_4.1.e000247.25","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00294-13"},{"key":"2025090109414691000_4.1.e000247.26","doi-asserted-by":"publisher","DOI":"10.1007\/s10792-008-9198-2"},{"key":"2025090109414691000_4.1.e000247.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2009.08.003"},{"key":"2025090109414691000_4.1.e000247.28","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1007\/s00415-009-5106-6","article-title":"Prognostic value of intrathecal antibody production and DNA viral load in cerebrospinal fluid of patients with herpes simplex encephalitis","volume":"256","author":"Hjalmarsson","year":"2009","journal-title":"J Neurol"},{"key":"2025090109414691000_4.1.e000247.29","doi-asserted-by":"crossref","unstructured":"Poissy J , Champenois K , Dewilde A , et al . Impact of herpes simplex virus load and red blood cells in cerebrospinal fluid upon herpes simplex meningo-encephalitis outcome. BMC Infect Dis 2012;12.doi:10.1186\/1471-2334-12-356","DOI":"10.1186\/1471-2334-12-356"},{"key":"2025090109414691000_4.1.e000247.30","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1111\/j.1469-0691.2007.01831.x","article-title":"High variability in viral load in cerebrospinal fluid from patients with herpes simplex and varicella-zoster infections of the central nervous system","volume":"13","author":"R\u016fzek","year":"2007","journal-title":"Clin Microbiol Infect"}],"container-title":["BMJ Open Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjophth-2018-000247","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T16:41:56Z","timestamp":1756744916000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjophth.bmj.com\/lookup\/doi\/10.1136\/bmjophth-2018-000247"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2019,4,9]]},"published-print":{"date-parts":[[2019,4]]}},"alternative-id":["10.1136\/bmjophth-2018-000247"],"URL":"https:\/\/doi.org\/10.1136\/bmjophth-2018-000247","relation":{},"ISSN":["2397-3269"],"issn-type":[{"value":"2397-3269","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4]]}}}