title: Delayed recurrence of acute retinal necrosis (ARN): A case series.
abstract: To report five cases of acute retinal necrosis (ARN) that reactivated in the same eye or presented in the contralateral eye between two and nineteen years after the initial episode of acute retinal necrosis.
  
  
  
  Five patients with a previous history of ARN developed recurrent ARN infection following a lengthy latency period. In all five patients who initially presented with unilateral disease, four developed infection in the contralateral eye and one developed recurrent infection in the ipsilateral eye. Latency periods ranged from two to nineteen years, and final visual acuity in the affected eyes ranged from 20/30 to no light perception. Each patient was treated with antiviral medication for both the initial infection and for subsequent reactivations, but was not on long-term prophylaxis at the time of recurrent disease.
  
  
  
  Although rare, delayed onset reactivation of ARN can occur in either the same eye or contralateral eye despite adequate treatment. While contralateral spread of initial infection is fairly common, these reactivations rarely occur more than six weeks after initial infection. Currently there are no guidelines for use of prophylactic antiviral medication to prevent late recurrence of ARN.
authors.affiliation: Case Western Reserve School of Medicine, 10900 Euclid Avenue, Room T408, Cleveland, OH 44106-4968, United States. Electronic address: cpd36@case.edu.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Donovan
authors.affiliation: Cleveland Clinic Foundation, Cole Eye Institute, 9500 Euclid Ave i32, Cleveland, OH 44195, United States. Electronic address: ashleigh.levison@gmail.com.
authors.forename: Ashleigh L
authors.initials: AL
authors.lastname: Levison
authors.affiliation: Cleveland Clinic Foundation, Cole Eye Institute, 9500 Euclid Ave i32, Cleveland, OH 44195, United States.
authors.forename: Careen Y
authors.initials: CY
authors.lastname: Lowder
authors.affiliation: Cleveland Clinic Foundation, Cole Eye Institute, 9500 Euclid Ave i32, Cleveland, OH 44195, United States.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Martin
authors.affiliation: Cleveland Clinic Foundation, Cole Eye Institute, 9500 Euclid Ave i32, Cleveland, OH 44195, United States. Electronic address: Srivass2@ccf.org.
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Srivastava
mesh_terms: D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011292:Premedication; D012008:Recurrence; D015882:Retinal Necrosis Syndrome, Acute / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000821:virology; D018139:Simplexvirus / Q000502:physiology; D017735:Virus Latency
chemical_list: D000998:Antiviral Agents
keywords: ARN antiviral prophylaxis; ARN recurrence; Acute retinal necrosis (ARN)