Acute retinal necrosis: a case series with clinical features and treatment outcomes

Authors: Sims, Joanne L; Yeoh, Jonathan; Stawell, Richard J

Source: Clinical & Experimental Ophthalmology, Volume 37, Number 5, July 2009 , pp. 473-477(5)

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Abstract:

Purpose:

To determine clinical features, viral aetiology and treatment outcomes of eyes with acute retinal necrosis (ARN). Methods:

Retrospective, interventional, non-comparative case series. Results:

Twenty-two patients (23 eyes) were identified between 1996 and 2007. Varicella zoster virus was the causative agent in 12 patients (nine confirmed by polymerase chain reaction), herpes simplex virus type 1 in six (five polymerase chain reaction-confirmed) and unknown in three patients. Five patients had documented herpes zoster infection in the month prior to the onset of ARN. Twelve patients (55%) had identifiable (clinical or subclinical) immune dysfunction. At 6 months, 3 out of 15 eyes (20%) maintained vision 6/12 or better and 7 (47%) were 6/60 or worse. Median final VA was 6/60. Nine eyes developed retinal detachment and two-thirds of these had received prior barrier laser. Poor prognostic factors for severe visual loss by univariate analysis were male gender (P = 0.019), and the development of retinal detachment (P = 0.05). Delay between onset of symptoms and diagnosis was associated with moderate visual loss (P = 0.018). Barrier laser did not reduce the risk of retinal detachment. Conclusions:

Acute retinal necrosis still has poor visual prognosis. Early diagnosis and initiation of treatment may improve outcome.

Keywords: acute retinal necrosis; barrier laser; herpetic; retinal detachment

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1442-9071.2009.02083.x

Publication date: 2009-07-01