We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
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 |

Vintage Progressive Outer Retinal Necrosis

Richard F. Spaide, MD1
[+] Author Affiliations
1Vitreous Retina Macula Consultants of New York, New York
JAMA Ophthalmol. 2015;133(2):230-231. doi:10.1001/jamaophthalmol.2014.4486.
Text Size: A A A
Published online


To the Editor I read with interest the article titled “Progressive Outer Retinal Necrosis (PORN): A Catchy Acronym But Is the Anatomy Correct? The Salient Observation of Lorenz E. Zimmerman, MD.”1 In 1996, my colleagues and I reported the first series of patients, to our knowledge, with the diagnosis of PORN who were successfully treated as defined by at least 1 eye retaining useful visual acuity.2 One of the patients had a retinal biopsy with electron and light microscopic examination, including immunohistochemistry. This patient had an extremely depressed CD4+ T-lymphocyte count and a chronic multidermatomal eruption of shingles on his back and buttocks. Although he had a typical appearance of PORN, the retinal biopsy showed full-thickness retinal necrosis. There were no cytoplasmic inclusions, and the patient had eosinophilic nuclear inclusions. Electron microscopy showed intranuclear inclusions of nucleocapsids typical of herpesvirus. Immunohistochemical staining was negative for cytomegalovirus and herpes simplex virus but there was diffuse reaction product in all layers of the retina for varicella-zoster virus. The predominant infiltrates in the retina were CD8+ lymphocytes, and these primarily were found in the inner retina, not the outer retina. A biopsy of one of the patient’s numerous skin lesions showed findings of a chronic varicella-zoster virus infection. Animal models of herpes retinitis, referenced in that article,2 suggested CD4+ cells were necessary to efficiently clear herpesvirus from the retina. The predominant lymphocyte found, CD8+ cells, may have been less efficient, allowing the infection to progress in this at-risk patient. This article was not referenced by Margo and Friedman.


Sign in

Purchase Options

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

First Page Preview

View Large
First page PDF preview





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.
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.


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

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...