Acute retinal necrosis: a case series with clinical features and treatment outcomes.
OBJECTIVE
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.
Sims
Joanne L
JL
Ocular Immunology Clinic, The Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia. josims98@yahoo.com
Yeoh
Jonathan
J
Stawell
Richard J
RJ
D000212:Acyclovir / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use; D001082:Aqueous Humor / Q000821:virology; D002648:Child; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006561:Herpes Simplex / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology; D006563:Herpes Zoster Ophthalmicus / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology; D018259:Herpesvirus 1, Human / Q000235:genetics / Q000302:isolation & purification; D014645:Herpesvirus 3, Human / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D015882:Retinal Necrosis Syndrome, Acute / Q000175:diagnosis* / Q000188:drug therapy* / Q000821:virology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014822:Vitreous Body / Q000821:virology; D055815:Young Adult
D000998:Antiviral Agents; D004279:DNA, Viral; D005938:Glucocorticoids; D000212:Acyclovir