Acute retinal necrosis: clinical features, early vitrectomy, and outcomes.
OBJECTIVE
To determine the viral diagnosis and the outcome of eyes with acute retinal necrosis (ARN) treated with intravenous acyclovir and oral prednisolone alone or combined with early vitrectomy and intravitreal acyclovir lavage.


METHODS
Nonrandomized, retrospective, interventional, comparative, consecutive series.


METHODS
A cohort of 27 human immunodeficiency virus-negative patients with ARN comprising 24 unilateral and 3 bilateral cases.


METHODS
Vitreous biopsy for viral diagnosis. Twenty eyes were treated with intravenous acyclovir in combination with oral prednisolone (group A). Ten eyes were treated additionally with early vitrectomy, intravitreal acyclovir lavage, laser demarcation of necrotic retinal areas when feasible-with or without scleral buckling, and gas or silicone oil tamponade (group B). Vitrectomy was performed in all cases of secondary rhegmatogenous retinal detachment (RD).


METHODS
Results of vitreous biopsy, rate of RD, rate of phthisis bulbi, and course of best-corrected visual acuity (BCVA).


RESULTS
Varicella zoster virus (VZV) was detected in 26 eyes, followed by herpes simplex virus (5 eyes), and Epstein-Barr virus (2 eyes, in conjunction with VZV). An RD developed in more eyes in group A (18 of 20 eyes) than in group B (4 of 10 eyes; P = 0.007). In 2 of 20 eyes in group A and in 0 of 10 eyes in group B, phthisis bulbi developed without a significant difference between groups A and B. Mean BCVA (logarithm of the minimum angle of resolution) at first visit was 1.09 (standard deviation [SD], 0.83), and mean final BCVA was 1.46 (SD, 0.88) without significant difference between groups A and B.


CONCLUSIONS
Varicella zoster virus is the leading cause of ARN. Visual prognosis is guarded. Early vitrectomy with intravitreal acyclovir lavage was associated with a lower incidence of secondary RD; however, it did not improve mean final visual acuity.
Hillenkamp
Jost
J
Department of Ophthalmology, University Medical Center Schleswig-Holstein, Kiel, Germany. hillenka@hotmail.com
Nölle
Bernhard
B
Bruns
Claudia
C
Rautenberg
Peter
P
Fickenscher
Helmut
H
Roider
Johann
J
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; D004359:Drug Therapy, Combination; 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; D006801:Humans; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D015882:Retinal Necrosis Syndrome, Acute / Q000175:diagnosis* / Q000628:therapy / Q000821:virology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy; D014822:Vitreous Body / Q000821:virology; D055815:Young Adult
D000998:Antiviral Agents; D005938:Glucocorticoids; D011239:Prednisolone; D000212:Acyclovir