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O.F. Brasil, C.Y. Lowder, D.M. Moshfeghi, J.E. Sears, P.K. Kaiser; Acute Retinal Necrosis Syndrome: Clinical Features And Outcome . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3059.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the clinical features and outcome of acute retinal necrosis (ARN) syndrome in patients seen at the Cole Eye Institute between 1988 and 2005.
Twenty–three eyes of 20 patients diagnosed and treated at our institution were included. Seven eyes of 6 patients without fundus color photographs at presentation or with a poor view of the fundus were excluded.
Involved eyes were divided into 2 groups based upon distinct patterns of retinitis. Thirteen eyes had peripheral retinitis and ten eyes had a predominantly multifocal punctate retinitis within the temporal arcade and in the periphery. Viral serology and vitreous fluid PCR were positive in every tested patient. In eyes with peripheral retinitis, 2 were positive only for herpes simplex virus, 2 were positive only for varicella zoster virus and 4 were positive for both. In eyes with multifocal punctate retinitis, 1 was positive only for herpes simplex virus, 3 were positive only for varicella zoster and 5 were positive for both. Mean age was 50.7 years old ±22.3 in the peripheral retinitis group where male female ratio was 2:1 and 51.9 years old ±12 in the multifocal punctate retinitis group where male female ratio was 1:1.5. Mean visual acuity in eyes with peripheral retinitis was 0.3 ±0.18 at presentation and 0.41 ±0.38 at last follow–up visit (mean follow–up of 1520.9 days ±1445) while in eyes with multifocal punctate retinitis it was 0.42 ±0.38 at presentation and 0.24 ±0.37 at last follow–up visit (mean follow–up of 2478.3 days ±1631.9). Iritis and prophylactic laser treatment (7 of 13 peripheral, 4 of 10 multifocal punctate) were similar in the 2 groups. Retinal detachment occurred in 6 eyes (46%) of patients with peripheral retinitis and in 8 eyes (80%) of patients with multifocal punctate retinitis. (Fisher exact test, p=0.11)
We report two distinct clinical patterns of retinitis in patients with ARN. The peripheral pattern is as described by the American Uveitis Society and the multifocal punctate pattern should be added to the American Uveitis Society definition. Our results are suggestive of a poorer prognosis in patients with the multifocal pattern.
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