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S. Winterhalter, C. Althaus, J. Stammen, E. M. Schöler, A. M. Joussen; Acute Retinal Necrosis - Variability in Clinical Course and Visual Outcome. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5139.
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© ARVO (1962-2015); The Authors (2016-present)
Acute retinal necrosis, caused by Herpes viruses, is a rare entity that mostly leads to poor visual outcome. We report our experiences of clinical course and visual outcome in 13 cases of acute retinal necrosis syndrome (ARN).
Thirteen patients with ARN were seen from 1991 untill 2006 in our department. Diagnosis was based on the Standard Diagnostic Criteria for the Acute Retinal Necrosis Syndrome of the American Uveitis Society and PCR of aqueous or vitreous tabs. Patients were treated with intravenous Acyclovir/ Foscarnet, intravitreal injections of Foscarnet and oral steroids depending on clinical course and treatment response. Prophylactic photocoagulation was performed in 7 eyes. Complicating retinal detachment was managed with pars plana vitrectomy with silicone oil endotamponade and endolaser. Patient histories were serched for bilaterality, immunosuppression, PCR virus prove, clinical course and final visual acuity.
In total, 4 females and 9 males were treated 29 to 77 years old (46,5 years mean age). Five patients (38,5%) were immunocompromized by HIV (3 cases) or CLL (2 cases). Diagnosis was made on clinical signs only in 6 patients. PCR examination achieved positive results in 5/7 patients (71%). Four of these five proved cases were positiv for VZV (80%) and one for HSV2. Three patients (19%), had a bilateral course of disease, 2 of these were immunocompromized. All patients were treated with i.v. Acyclovir. Additional intravitreal injections of Foscarnet were required in 2 patients as a supplement to the i.v. Acyclovir regimen. Although 7 patients underwent prophylactic photocoagulation 5 patients (71%) progressed to retinal detachment. In total 8 eyes from 7 patients (50%) developed retinal detachment. Total mean VA was measured with 0,5 log MAR ranging from no visual function to -0,1 log MAR. Final VA remained below reading ability in 12 eyes (75%) ranging from no light perception to 0,4 log MAR (mean VA 1,0 log MAR). Immunocompromized patients showed a lower mean VA (0,9 log MAR) than immunocompetent (0,3 log MAR). Disease complications such as severe arteriitis with combined central artery and vein occlusion, retinal and macula detachment, macula edema and optic atrophy explained VA below 1,0 log MAR (8 eyes, 50%).
Immunocompromized background and ARN complications lead to poor visual outcome in ARN. Confirmation of early diagnosis through PCR is recommended to improve medical management and prevent disease progression with increased risk of complications.
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