Clinical feature and visual prognosis of acute retinal necrosis according to the initially involved zone and extent: 10-year experience

Abstract

Purpose:

We aimed to analyze the visual prognosis and clinical characteristics of acute retinal necrosis according to the initially involved zone and extent.

Study design:

Retrospective, consecutive, cross-sectional study.

Methods:

We retrospectively reviewed acute retinal necrosis patients who were treated with systemic antiviral treatment, and assessed the visual prognosis of acute retinal necrosis following antiviral treatment based on the initially involved zone and the extent of acute retinal necrosis at the time of diagnosis. Moreover, we evaluated whether prophylactic laser photocoagulation had preventive effects on retinal detachment.

Results:

A total of 43 eyes from 35 patients with acute retinal necrosis were included. Eyes with zone I involvement/extensive retinal lesions showed poor visual prognosis (logMAR: 1.17 ± 0.97 vs 0.49 ± 0.81; p = 0.014) and a higher incidence of retinal detachment (9/30 (30.0%) vs 0/13 (0%); p = 0.039) after treatment. Retinal detachment was observed in 20.9% of cases, and its incidence was significantly lower in eyes that had undergone prophylactic laser photocoagulation.

Conclusion:

The overall visual prognosis of acute retinal necrosis is poor and can be determined at the time of diagnosis. Prophylactic laser photocoagulation exhibits preventive effects with regard to the development of retinal detachment. Therefore, laser photocoagulation should be actively considered in eyes with extensive retinal lesions to prevent retinal detachment and thus eventually improve the overall visual prognosis of acute retinal necrosis.

Keywords

Acute retinal necrosis prophylactic laser photocoagulation retinal detachment visual prognosis treatment

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References

de Boer

Luyendijk

Rothova

et al . Detection of intraocular antibody production to herpesviruses in acute retinal necrosis syndrome. Am J Ophthalmol 1994; 117(2): 201–210.

Nishi

Hanashiro

Mori

et al . Polymerase chain reaction for the detection of the varicella-zoster genome in ocular samples from patients with acute retinal necrosis. Am J Ophthalmol 1992; 114(5): 603–609.

Lewis

Culbertson

Post

et al . Herpes simplex virus type 1. A cause of the acute retinal necrosis syndrome. Ophthalmology 1989; 96(6): 875–878.

Culbertson

Blumenkranz

Pepose

et al . Varicella zoster virus is a cause of the acute retinal necrosis syndrome. Ophthalmology 1986; 93(5): 559–569.

Nussenblatt

RB.

Uveitis: fundamentals and clinical practice. 3rd ed. Philadelphia, PA: Mosby, 2004.

Hillenkamp

Nolle

Bruns

et al . Acute retinal necrosis: clinical features, early vitrectomy, and outcomes. Ophthalmology 2009; 116(10): 1971–1975.

Luu

Scott

Chaudhry

et al . Intravitreal antiviral injections as adjunctive therapy in the management of immunocompetent patients with necrotizing herpetic retinopathy. Am J Ophthalmol 2000; 129(6): 811–813.

Clarkson

Blumenkranz

Culbertson

et al . Retinal detachment following the acute retinal necrosis syndrome. Ophthalmology 1984; 91(12): 1665–1668.

Aizman

Johnson

Elner

SG.

Treatment of acute retinal necrosis syndrome with oral antiviral medications. Ophthalmology 2007; 114(2): 307–312.

10.

Iwahashi-Shima

Azumi

Ohguro

et al . Acute retinal necrosis: factors associated with anatomic and visual outcomes. Jpn J Ophthalmol 2013; 57(1): 98–103.

11.

Jabs

DA.

Ocular manifestations of HIV infection. Trans Am Ophthalmol Soc 1995; 93: 623–683.

12.

Holland

Buhles

Jr Mastre

et al . A controlled retrospective study of ganciclovir treatment for cytomegalovirus retinopathy. Use of a standardized system for the assessment of disease outcome. UCLA CMV retinopathy. Study group. Arch Ophthalmol 1989; 107(12): 1759–1766.

13.

Lange

Feltgen

Junker

et al . Resolving the clinical acuity categories “hand motion” and “counting fingers” using the Freiburg Visual Acuity Test (FrACT). Graefes Arch Clin Exp Ophthalmol 2009; 247(1): 137–142.

14.

Han

Lewis

Williams

et al . Laser photocoagulation in the acute retinal necrosis syndrome. Arch Ophthalmol 1987; 105(8): 1051–1054.

15.

Crapotta

Freeman

Feldman

et al . Visual outcome in acute retinal necrosis. Retina 1993; 13(3): 208–213.

16.

Tibbetts

Shah

Young

et al . Treatment of acute retinal necrosis. Ophthalmology 2010; 117(4): 818–824.

17.

McDonald

Lewis

Kreiger

et al . Surgical management of retinal detachment associated with the acute retinal necrosis syndrome. Br J Ophthalmol 1991; 75(8): 455–458.

18.

Luo

Duan

Chen

et al . Efficacy and necessity of prophylactic vitrectomy for acute retinal necrosis syndrome. Int J Ophthalmol 2012; 5(4): 482–487.

19.

Matsuo

Timing of prophylactic and early vitrectomy for first-presenting or recurrent acute retinal necrosis syndrome. Acta Med Okayama 2012; 66(6): 493–497.

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