Association Between Prognosis of Acute Retinal Necrosis and Retinal Involvement

Turk J Ophthalmol. 2022 Dec 28;52(6):405-411. doi: 10.4274/tjo.galenos.2021.58609.

Abstract

Objectives: The aims of this study were to describe the clinical presentation and treatment modalities of acute retinal necrosis (ARN) and to evaluate complications and clinical outcomes according to the extent of retinal involvement at initial presentation.

Materials and methods: The medical records of 52 patients diagnosed with ARN were reviewed and 48 were included in the study. Patients were categorized into two groups according to the extent of retinitis at presentation: retinal involvement of 1-2 quadrants (Group A) or 3-4 quadrants (Group B).

Results: The mean age of the 14 women and 34 men at presentation was 51.3±13.6 years (range: 27-78). There were 40 unilateral and 8 bilateral cases. There were 11 eyes (19.6%) in Group A and 45 eyes (80.4%) in Group B. Eleven patients (22.9%) had a history of herpes simplex virus/varicella-zoster virus infection. One patient in Group A and 11 patients in Group B had received local or systemic corticosteroid therapy without concomitant antiviral treatment before referral. The median follow-up period was 29 months (range: 1-209) in Group A and 8.5 months (range: 0.75-209) in Group B. Mean visual acuity (VA) at presentation was 0.42±0.55 LogMAR (range: 0-2.0) in Group A and 1.28±0.95 LogMAR (range: 0-2.9) in Group B (p<0.05). The presence of endothelial keratic precipitates at presentation was significantly different between two groups (p=0.021). Retinal detachment (RD) occurred in 1 eye (9.1%) in Group A and 30 eyes (66.7%) in Group B (p<0.001). Optic disc pallor was seen in 36.4% (4/11) of eyes in Group A and 71.1% (32/45) of eyes in Group B (p=0.033). Other ocular complications were not significantly different between two groups. Mean final visual acuity was 0.29±0.41 LogMAR in Group A and 1.61±0.90 LogMAR in Group B (p<0.05).

Conclusion: The extent of retinal involvement at presentation affects visual outcomes and this shows the importance of early diagnosis and early initiation of antiviral treatment.

Keywords: Acute retinal necrosis; antiviral agents; herpes simplex virus; retinal detachment; varicella-zoster virus; viral retinitis.

MeSH terms

  • Adult
  • Aged
  • Antiviral Agents / therapeutic use
  • Eye Infections, Viral* / complications
  • Eye Infections, Viral* / diagnosis
  • Female
  • Herpes Simplex* / diagnosis
  • Herpes Simplex* / drug therapy
  • Herpes Zoster Ophthalmicus* / complications
  • Herpes Zoster Ophthalmicus* / diagnosis
  • Herpes Zoster Ophthalmicus* / drug therapy
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Retinal Necrosis Syndrome, Acute* / diagnosis
  • Retinal Necrosis Syndrome, Acute* / drug therapy

Substances

  • Antiviral Agents