[Acute retinal necrosis syndrome. Lausanne cases, review of the literature and new physiopathogenetic hypothesis].
OBJECTIVE
The purpose of this study was to analyse our ARN-patients, perform an extensive review of the literature, suggest a physiopathogenic hypothesis for the disease that should influence the therapeutical approach of these cases.


METHODS
From 1985 to 1993, 15 HIV-negative cases of ARN were seen in our clinic. Eleven cases were analysed prospectively: the herpetic agent involved in each case was searched for by the determination of intraocular specific antibody production and a complete immunological work-up was performed.


RESULTS
Our collective included 4 cases of bilateral ARN (BARN). In 9 cases the clinical presentation was that of a typical ARN, in 3 cases ARN was of the "mild-type" and in 3 cases lesions were multifocal involving initially the posterior pole resembling the clinical picture of PORN (progressive outer retinal necrosis). The viral agent was varicella-zoster virus in 7 cases, herpes simplex virus in 3 cases, cytomegalovirus in 1 case and was not determined in 4 cases. In the 216 published cases a state of immunodepression was found in 15.7%. In our group with systematic immunological work-up this rate was 46%.


CONCLUSIONS
This is in support of the thesis that an immune dysfunction is probably at the origin of ARN. We therefore suggest to avoid to add systemic steroids to the specific antiviral therapy but to treat inflammation by periocular steroids.
Rochat
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Hôpital Jules Gonin, Service d'ophtalmologie, Université de Lausanne.
Herbort
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CP
D000914:Antibodies, Viral / Q000032:analysis; D017726:Cytomegalovirus Retinitis / Q000175:diagnosis / Q000276:immunology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006563:Herpes Zoster Ophthalmicus / Q000175:diagnosis / Q000276:immunology / Q000628:therapy; D006566:Herpesviridae Infections / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D006801:Humans; D016849:Keratitis, Herpetic / Q000175:diagnosis / Q000276:immunology / Q000628:therapy; D008297:Male; D011446:Prospective Studies; D012166:Retinal Hemorrhage / Q000175:diagnosis / Q000276:immunology / Q000628:therapy; D015882:Retinal Necrosis Syndrome, Acute / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy
D000914:Antibodies, Viral
Syndrome de nécrose rétinienne aiguë (ARN/BARN/PORN). Casuistique lausannoise, revue de la littérature et nouvelle hypothèse physiopathogénique.