Acute retinal necrosis: clinical features, management and outcomes

• Published in: International ophthalmology 2023-06, Vol.43 (6), p.1987-1994
• Main Authors: Ozdemir Yalcinsoy, Kubra, Cakar Ozdal, Pinar, Inanc Tekin, Merve, Karatepe, Mustafa Salih, Ozdamar Erol, Yasemin
• Format: Article
• Language: English
• Subjects: Acuity; Adult; Antiviral agents; Antiviral Agents - therapeutic use; Chicken pox; Cytomegalovirus; Eye; Eye (anatomy); Eye Infections, Viral - drug therapy; Eye Infections, Viral - therapy; Female; Ganciclovir; Herpes simplex; Herpes viruses; Herpesvirus 3, Human; Humans; Male; Medicine; Medicine & Public Health; Necrosis; Ophthalmology; Original Paper; Patients; Polymerase chain reaction; Retina; Retinal Detachment - surgery; Retinal Necrosis Syndrome, Acute - diagnosis; Retinal Necrosis Syndrome, Acute - therapy; Retrospective Studies; Statistical analysis; Varicella; Vasculitis; Viruses; Visual acuity; Visual aspects; Vitrectomy - adverse effects; Vitreous Body
• ISSN: 1573-2630; 0165-5701; 1573-2630
• DOI: 10.1007/s10792-022-02598-7

Purpose To evaluate the clinical features, treatment, and visual outcome of patients with acute retinal necrosis (ARN). Methods The data of patients were retrospectively reviewed. Factors associated with visual loss and factors affecting the risk for retinal detachment (RD) development were evaluated. Results Twenty-four eyes of 24 patients (7 female/17 male, mean age 43.7 years, mean follow-up period 31.0 months) were included. In ocular fluid samples of 15 (83%) out of 18 eyes, polymerase chain reaction (PCR) tests were positive for herpes simplex virus (seven eyes; 39%), varicella zoster virus (six eyes; 33%), cytomegalovirus (one eye; 6%), and adenovirus (one eye; 6%). Central retinal occlusive vasculitis was observed in three (13%) eyes. Systemic antiviral therapy was given to all patients, and additional intravitreal ganciclovir was administered in seven eyes (29%). The most common complication was RD (46%). There was no statistically significant difference in the frequency of RD between herpes simplex virus- and varicella zoster virus-positive patients ( p  = .617). The rate of RD was similar in eyes undergoing prophylactic laser photocoagulation (LPC), eyes undergoing vitrectomy + LPC, and eyes not undergoing LPC ( p  = .237). The number of eyes with final visual acuity below 20/200 was significantly higher in eyes with RD than without RD ( p  = .047). Conclusion Prophylactic LPC and vitrectomy did not show clear benefits in terms of preventing RD development. RD was the most common complication and a major factor for a poor visual prognosis.