0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Comment & Response |

Could Progressive Outer Retinal Necrosis Begin With Retinal Deep Capillary Ischemia?—Reply

Curtis E. Margo, MD, MPH1,2; Scott M. Friedman, MD3
[+] Author Affiliations
1Department of Ophthalmology, University of South Florida Morsani College of Medicine, Tampa
2Department of Pathology and Cell Biology, University of South Florida Morsani College of Medicine, Tampa
3Florida Retina Consultants, Lakeland
JAMA Ophthalmol. 2015;133(1):111-112. doi:10.1001/jamaophthalmol.2014.3550.
Text Size: A A A
Published online

Extract

In Reply Yu and Freund propose that the conflicting clinical and histological observations in PORN could be explained by retinal whitening from vascular occlusion of deep retinal capillaries, a process that immediately precedes inner retina injury followed by photoreceptor involvement. They base this hypothesis on recent observations by Sarraf et al,1 who used high-resolution spectral-domain OCT in paracentral acute middle maculopathy. Previous studies describing OCT findings in patients with PORN, however, were done with time-domain OCT, so details of specific layers of affected retina were not discernible. Having the proposed mechanism of Yu and Freund in mind, we reviewed the remaining slides from the case of PORN that showed partial-thickness necrosis, specifically looking for evidence of retinal microvascular disease. At this stage of the infection, no small retinal capillaries could be found on hematoxylin-eosin–stained sections; only larger-diameter vessels in the inner retina were found. These vessels did not appear occluded. Not mentioned in our earlier article2 was the disproportionately larger number of intranuclear inclusions (viral inclusions) in the inner nuclear layer compared with the outer nuclear layer (Figure). Almost all nuclei of the inner nuclear layer contained red inclusion bodies, while viral inclusions were found substantially less often in nuclei of photoreceptors (Figure, inset). From a solely morphological perspective, the infection appears to spread contiguously. This, however, does not adequately explain the early clinical appearance of deep retinal whitening when more advanced involvement appears in the inner retina histologically. We suspect such riddles will eventually be solved through the use of new technologies and thoughtful analysis like that presented by Yu and Freund.

Figures in this Article

Topics

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview

Figures

Place holder to copy figure label and caption
Figure.
Partial Retinal Necrosis in So-Called Progressive Outer Retinal Necrosis

Partial retinal necrosis in so-called progressive outer retinal necrosis, showing relative preservation of the inner nuclear layer (IN) and the outer nuclear layer (hematoxylin-eosin, scale bar = 85 µm). Inset, Virtually every nucleus of the inner nuclear layer contains a red inclusion body (arrowheads), while only a few suspicious cells are visible among photoreceptor nuclei (hematoxylin-eosin, scale bar = 18 µm).

Graphic Jump Location

Tables

References

Correspondence

January 1, 2015
Suqin Yu, MD; K. Bailey Freund, MD
1Department of Ophthalmology, Shanghai Jiao Tong University Affiliated First People’s Hospital, Shanghai, China
2Vitreous-Retina-Macula Consultants of New York, New York
JAMA Ophthalmol. 2015;133(1):110-111. doi:10.1001/jamaophthalmol.2014.3548.
February 1, 2015
Richard F. Spaide, MD
1Vitreous Retina Macula Consultants of New York, New York
JAMA Ophthalmol. 2015;133(2):230-231. doi:10.1001/jamaophthalmol.2014.4486.
February 1, 2015
Curtis E. Margo, MD, MPH; Scott M. Friedman, MD
1Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa2Department of Pathology and Cell Biology, Morsani College of Medicine, University of South Florida, Tampa
3Florida Retina Consultants, Lakeland
JAMA Ophthalmol. 2015;133(2):231. doi:10.1001/jamaophthalmol.2014.4512.
CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

224 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Jobs
brightcove.createExperiences();