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Laura J Kopplin, Stephanie Cramer, Steven Yeh, Christina J Flaxel; Long-term surgical outcomes of acute retinal necrosis. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5800.
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To assess the long-term visual, anatomic and surgical outcomes in patients with acute retinal necrosis (ARN), including rates of recurrent detachment following primary surgical repair. To determine if prior intravitreal foscarnet therapy reduced the rate of recurrent retinal detachment.
We conducted a single center retrospective chart review from 2001-2012 of patients diagnosed with ARN. We assessed the development of retinal detachment, types of surgical interventions and the occurrence of recurrent retinal detachment after surgical repair. We compared the rates of recurrent detachment between those receiving and not receiving intravitreal foscarnet using Fisher’s exact test.
We identified 32 eyes from 27 patients with ARN (5 with bilateral disease). Mean follow up was 51.8 months (range 7-206). All subjects received systemic treatment with either intravenous followed by oral acyclovir or oral valacyclovir alone and a subset of eyes (50%) were treated with intravitreal foscarnet. Fifteen eyes (46.9%) developed retinal detachments and 13 under went surgical repair. Primary intervention consisted of pars plana vitrectomy with silicone oil in 7 cases (53.8%), pars plana vitrectomy in combination with scleral buckle and silicone oil in 4 cases (30.8%) and pars plana vitrectomy with either scleral buckle (1 case) or cryotherapy (1 case). Recurrent retinal detachment developed in 7 eyes (53.8%) occurring 35 days to 10 months after the primary retinal surgery. There was no difference in the rate of recurrent detachment between eyes treated with or without intravitreal foscarnet (p=0.74), although sample size limits comparison. Three recurrent detachments happened after removal of silicone oil (between 1 day and 3.5 months after the procedure). At final follow up, all retinas that underwent repair remained attached. Acuities at the last recorded visit ranged from 20/40 to no light perception; vision improved in 30.8% of patients who underwent retinal repair.
We found a rate of retinal detachment secondary to ARN similar to that previously reported. Recurrent retinal detachment after primary surgical repair was a frequent complication and the rate of recurrent detachment did not differ based on prior treatment with foscarnet. Overall, visual prognosis was poor despite surgical intervention.
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