Acute retinal necrosis in the United Kingdom: results of a prospective surveillance study

Eye (Lond). 2012 Mar;26(3):370-7; quiz 378. doi: 10.1038/eye.2011.338. Epub 2012 Jan 27.


Background: To determine the incidence of acute retinal necrosis (ARN) in the United Kingdom and to describe the demographics, management, and visual outcome in these patients.

Methods: This was a prospective study carried out by the British Ophthalmological Surveillance Unit (BOSU) between September 2007 and October 2008. Initial and 6-month questionnaires were sent to UK ophthalmologists who reported cases of ARN via the monthly BOSU report card system.

Results: In all, 45 confirmed cases (52 eyes) of ARN were reported in the 14-month study period, giving a minimum incidence of 0.63 cases per million population per year. There were 20 females and 25 males. Age ranged from 10 to 94 years. Eight patients had a history of herpetic CNS disease. Aqueous sampling was carried out in 13 patients, vitreous in 27, and cerebrospinal fluid (CSF) in 4. Varicella-zoster virus followed by herpes simplex were the most common causative agents. Treatment in 76% of the cases was with intravenous antivirals; however, 24% received only oral antivirals. In all, 47% of patients had intravitreal antiviral therapy. Visual outcome at 6 months was <6/60 in 48% of the affected eyes.

Conclusion: The minimum incidence of ARN in the UK is 0.63 cases per million. Patients with a history of herpetic CNS disease should be warned to immediately report any visual symptoms. There is increased use of oral and intravitreal antivirals in initial treatment.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antiviral Agents / administration & dosage
  • Child
  • Female
  • Herpes Simplex / epidemiology
  • Herpes Zoster / epidemiology
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Population Surveillance
  • Prospective Studies
  • Retinal Necrosis Syndrome, Acute / drug therapy
  • Retinal Necrosis Syndrome, Acute / epidemiology*
  • Retinal Necrosis Syndrome, Acute / virology
  • United Kingdom / epidemiology
  • Visual Acuity
  • Young Adult


  • Antiviral Agents