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. 2000 Feb;84(2):193–198. doi: 10.1136/bjo.84.2.193

Variable R1 region in varicella zoster virus in fulminant type of acute retinal necrosis syndrome

T Abe 1, M Sato 1, M Tamai 1
PMCID: PMC1723368  PMID: 10655197

Abstract

BACKGROUND/AIMS—Varicella zoster virus (VZV) is a causative agent in acute retinal necrosis (ARN) syndrome. However, in spite of aggressive antiviral therapy, clinical characteristics among patients have varied. Different viral strains were examined to determine their respective role in producing clinical characteristics. The viral strains were also compared with those of previously reported ones.
METHODS—To differentiate VZV strains R1 and R5, variable regions of VZV were amplified by nested polymerase chain reaction (PCR) in 11 eyes of 10 patients. Sequence analysis was also performed.
RESULTS—Four cases had strains diverted only at the tip of the 3' end of the R1 variable region, similar to that of the H-N3 strain, which was previously reported. Conversely, other cases were diverted to other regions. Interestingly, some of the latter cases showed multiple PCR products in the R1 region that were generated by the truncation of either the 5' or 3' R1 region. Final visual acuities of these patients were less than 0.2. The former cases showed final visual acuities more than 0.4. Only two variants were from the R5 region. No patient had the same viral strain as the European Dumas type.
CONCLUSION—These results showed that variable VZV strains participated in ARN. Using PCR of the R1 variable region, it was estimated that patients with a more fulminant type of ARN may have diverse viruses with extensive replication in the affected eyes.



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Figure 1  .

Figure 1  

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Fundus photographs of patients 1 and 11. Mild arteritis close to the optic disc and mid-peripheral areas are seen in patient 1. Mild retinal exudates occur at the far periphery of the temporal region, which is not clearly visible (A). Conversely, the fundus of case 11 shows extensive retinal exudates with retinal haemorrhages in almost all the retinal regions except the macular area (B).

Figure 2  .

Figure 2  

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The results of the PCR of the R1 variable region are shown. Each number of the upper lane indicates the patient number, N; negative control, M; 100 base pair marker. Patients 5 and 6 represent both eyes of one patient who had bilateral infection. Repeated aqueous taps were performed in cases 5 (5-1 and 5-2) and 7 (7-1, 7-2, and 7-3) during their follow up examination. Exact amplification size of each PCR product in patients 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, and 11 (larger bands) were 464, 464, 497, 497, 509, 509, 416, 464, 464, 461, and 497 base pairs, respectively.

Figure 3  .

Figure 3  

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Construction of R1 variable region3 23; for each element see key. Dumas type was reported by Davison and Scott2 and H-S1, H-N3, and YS strains were reported by Kinoshita and coworkers.3

Figure 4  .

Figure 4  

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The results of PCR of the R5 variable region demonstrated two types of PCR products. The amplification sizes were 548 (patient 4) and 436 (other patients) base pairs. The R5 variable region was never amplified in case 2, in spite of repeated examinations. Abbreviations are the same as in Figure 2.

Figure 5  .

Figure 5  

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Construction of R5 variable region24; for each element see key. Dumas type was reported by Davison and Scott2 and H-S1, H-N3, and YS strains were reported by Hondo and coworkers.23

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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