Objective: To investigate relevant factors affecting the prognosis of acute retinal necrosis syndrome (ARN).
Methods: Case-series study. The clinical data of 41 patients (53 eyes) with ARN were retrospectively analyzed. Eyes were divided into two groups according to best corrected visual acuity at final visit. The groups were best corrected visual acuity better than 0.1 (group A, 28 eyes) and worse than 0.1 (group B, 25 eyes). Data were analyzed using the χ(2) test, Fisher exact test, Mann-Whitney test, bivariate correlation statistics, and multinomial logistic regression analysis.
Results: All patients were treated with systemic antivirus drugs and glucocorticoid. Ten eyes were treated with prophylactic laser retinopexy, 26 eyes underwent intravitreal ganciclovir, and 31 eyes underwent vitrectomy. All contralateral eyes of unilateral ARN patients were not involved after systemic antivirus treatment. Compared to group B (16.0%, 4/25), more eyes with best corrected visual acuity better than 0.1 at first visit were observed in group A (85.7%, 24/28) (χ(2) = 23.037, P = 0.000). Duration from onset of symptoms until first administration of antivirus drugs was shorter in group A [(15 ± 13) days] than in group B [(30 ± 34) days, Z = -2.414, P = 0.016]. Compared to group A (25.0%, 7/28; 10.7%, 3/28; 7.1%, 2/28; 39.3%, 11/28), more eyes in group B suffered from retinal detachment (80.0%, 20/25), occlusive central retinal vasculopathy (56.0%, 14/25), optic atrophy (36.0%, 9/25) and proliferative vitreoretinopathy (92.0%, 23/25) (χ(2) = 13.862, 10.440, 5.048, 13.749; P = 0.000, 0.001, 0.025, 0.000). Logistics regression analysis showed that visual prognosis were related to factors including best corrected visual acuity better at first visit (OR = 27.225, P = 0.003) and occlusive central retinal vasculopathy (OR = 0.065, P = 0.053). No difference in the number of eyes with increased intraocular pressure was observed between group A and group B (P > 0.05). Prophylactic laser retinopexy before retinal detachment and intravitreal ganciclovir were not associated with visual prognosis (P > 0.05).
Conclusion: Worse visual acuity at first visit and occlusive central retinal vasculopathy are major relevant factors threatening visual prognosis.