Varicella zoster virus associated non-necrotizing retinopathy:Three case reports and literature review

Purpose : To report the clinical features, diagnostic approaches, and therapeutic outcomes of three cases of varicella zoster virus (VZV)-associated non-necrotizing retinopathy (NNHR) and review the relevant literature. Methods : Clinical data were collected by reviewing the medical records of three patients diagnosed with NNHR. Results : All patients presented with unilateral vision loss, accompanied by anterior chamber and vitreous inflammation, but lacked peripheral retinal necrosis. Two patients were detected with VZV through aqueous humor PCR testing, while one patient was identified via metagenomic testing. Post-treatment, visual acuity improved significantly, with resolution of inflammation, absorption of retinal vascular sheathing, and no necrotic lesions during follow-up. Conclusion : NNHR should be suspected in cases of significant vitritis with concomitant retinal vasculitis to avoid misdiagnosis as idiopathic uveitis. Early PCR testing of intraocular fluid is critical for definitive diagnosis. Prompt systemic antiviral therapy effectively improves visual outcomes and mitigates inflammation.