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G. Heidary, E. Chaum, S. Mukai; Acute Retinal Necrosis in Children . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5271.
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© ARVO (1962-2015); The Authors (2016-present)
To report on the management and outcome of children diagnosed with acute retinal necrosis (ARN).
Retrospective case review of all cases of ARN in patients under the age of 18 years seen in the Retina Service of Massachusetts Eye and Ear Infirmary between 1995 and 2005. Children underwent complete ophthalmic and systemic evaluations including extensive serologic analysis.
Two cases of pediatric ARN were identified. Case 1 was diagnosed at 11 years of age and presented with conjunctival injection and blurred vision at 20/60 OD. Examination revealed rapidly progressive acute retinitis involving the midperipheral and posterior superonasal retina extending into the optic disc. Serology was positive for exposure to CMV and VZV. Case 2 was diagnosed at 16 years of age and presented with blurred vision at 20/200 OD. Examination revealed acute retinitis nasally with uveitis. Serology was positive for exposure to VZV. There was no recent history of illness including chickenpox or immunosuppressive disorder. Each patient was treated with intravenous (IV) antiviral (case 1 acyclovir, case 2 foscarnet) and oral/topical steroid therapy. In both cases, combined traction and rhegmatogenous retinal detachment (RD) occurred within 2 months. Successful retinal reattachment was achieved with pars plana vitrectomy, lensectomy, membrane peel and intraocular tamponade. Case 1 has experienced 5 recurrences, each detected early with good response to IV antiviral therapy; no recurrences have been documented for case 2. Final visual acuity was 20/25 in each case.
ARN is a potentially devastating disease that is rare in children. Both cases were presumed to be from VZV and responded to intensive IV antiviral therapy. They developed complex RD that was successfully repaired by aggressive surgery with preservation of excellent vision. This highlights the importance of prompt diagnosis and treatment.
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