Acute retinal necrosis features, management, and outcomes.
OBJECTIVE
To determine the viral diagnosis and factors affecting the visual outcome of eyes with acute retinal necrosis.


METHODS
Nonrandomized, retrospective, interventional, noncomparative series.


METHODS
A cohort of 22 human immunodeficiency virus-negative patients with acute retinal necrosis (ARN). There were 17 unilateral and 5 bilateral cases.


METHODS
Diagnostic vitreous biopsy for polymerase chain reaction (PCR) viral DNA analysis, prophylactic barrier laser posterior to necrotic retina to try to prevent rhegmatogenous retinal detachment (RD), intravenous acyclovir in combination with oral, and vitrectomy for RD repair.


METHODS
Results of PCR viral DNA analysis, relationship between prophylactic barrier argon laser photocoagulation and occurrence of RD, and visual acuities at presentation and follow-up.


RESULTS
Varicella-zoster virus (VZV) was detected in 66.7% (12/18) of eyes (66.7% of patients [10/15]) with vitreous biopsy and herpes simplex virus (HSV) in 22.2% (4/18) of eyes (20% of patients [3/15]). Epstein-Barr virus (EBV) was detected in 16.7% (3/18) of eyes (20% of patients [3/15]), and all the EBV-positive eyes were also positive for VZV. Polymerase chain reaction results were identical in both eyes of bilateral cases (5 patients) and were negative in 11.1% (2/18) of eyes (13.3% of patients [2/15]) biopsied. Systemic corticosteroid treatment given before ARN diagnosis did not appear to increase the risk of developing RD (P = 0.69). Rhegmatogenous RD occurred in 35.3% (6/17) of eyes given prophylactic argon laser treatment and in 80% (8/10) of eyes that could not be lasered prohylactically. Of RDs, 96.3% (13/14) occurred after the third week and up to 5 months from onset of symptoms. The VA after surgical repair of RD improved relative to the presentation acuity in 33.3% (4/12) of eyes.


CONCLUSIONS
Varicella-zoster virus is the leading cause of ARN. We recommend the management of ARN to include prompt diagnosis; prophylactic argon laser retinopexy, preferably within the first 2 weeks to reduce risk of RD; systemic acyclovir; and corticosteroids to control the severe inflammation associated with ARN. Despite the guarded visual prognosis, RD repair may result in improved visual outcomes.
Lau
Chun H
CH
Department of Clinical Ophthalmology, Institute of Ophthalmology and Moorfields Eye Hospital, London, United Kingdom.
Missotten
Tom
T
Salzmann
Joel
J
Lightman
Susan L
SL
D000212:Acyclovir / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004279:DNA, Viral / Q000032:analysis; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis / Q000628:therapy / Q000821:virology; D015828:Eye Infections, Viral / Q000175:diagnosis* / Q000628:therapy* / Q000821:virology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006561:Herpes Simplex / Q000175:diagnosis / Q000628:therapy / Q000821:virology; D006563:Herpes Zoster Ophthalmicus / Q000175:diagnosis / Q000628:therapy / Q000821:virology; D018259:Herpesvirus 1, Human / Q000235:genetics / Q000302:isolation & purification; D018258:Herpesvirus 2, Human / Q000235:genetics / Q000302:isolation & purification; D014645:Herpesvirus 3, Human / Q000235:genetics / Q000302:isolation & purification; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012163:Retinal Detachment / Q000209:etiology / Q000517:prevention & control; D015882:Retinal Necrosis Syndrome, Acute / Q000175:diagnosis* / Q000628:therapy* / Q000821:virology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014821:Vitrectomy; D014822:Vitreous Body / Q000821:virology
D000998:Antiviral Agents; D004279:DNA, Viral; D005938:Glucocorticoids; D000212:Acyclovir