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W. Wu, A. Brucker, A. Maguire; A Case Series of Acute Retinal Necrosis Syndrome: Persistent Low–Grade Ocular Inflammation . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5640.
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© ARVO (1962-2015); The Authors (2016-present)
To report a case series of five patients with the acute retinal necrosis syndrome (ARN) who developed persistent low–grade ocular inflammation after initial treatment.
A retrospective review was performed of the clinical records of five patients who were diagnosed with ARN between September, 1999 and Feburary, 2002, and who were successfully treated with high dose intravenous antiviral therapy. The clinical course and the presence of low–grade ocular inflammation after treatment are described. The follow–up period ranged from 24 months to 60 months.
All five patients had ARN, and developed persistent ocular inflammation after cessation of retinitis activity. Two patients had bilateral ARN; three patients had unilateral disease. All five patients received intravenous acyclovir which was followed by several months (range 3 to 5 months) of oral antiviral treatment. One patient also received intravitreal foscarnet. One patient developed a tractional retinal detachment, and three patients developed rhegmatogenous or combined tractional and rhegmatogenous retinal detachments. These four patients underwent pars plana vitrectomy. All five patients had persistent low–grade anterior and vitreous inflammation. Three patients (four eyes) developed secondary cystoid macula edema subsequently treated with either retrobulbar or periocular kenolog injection in addition to topical steroidal treatment. One patient developed bilateral band keratopathy secondary to chronic anterior uveitis. All patients developed posterior subcapsular cataracts and had subsequent cataract surgery with implantation of IOL's. One patient developed recurrent pigmentary deposits on the IOL similar to keratic precipitates secondary to recurrent anterior uveitis.
Systemic antiviral therapy is effective in treating the initial viral infection and preventing later occurrence of acute retinal necrosis. Persistent ocular inflammation may be seen after cessation of retinitis and may be related to persistent immune reaction from previous viral infection.
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