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Katharina Blobner, Mathias Maier, Chris Patrick Lohmann, Christian Mayer; Importance of Early Treatment of Acute Retina Necrosis - A Case Series. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4174. doi: https://doi.org/.
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The Acute Retina Necrosis (ARN) is an inflammatory, rapidly progressive and mostly necrotizing retinitis and vasculitis. As a rare form of herpetic uveitis, patients of all ages or gender can be affected. In the pathogen proof most frequently Varizella-Zoster-Virus (VZV) can be found, followed by Herpes-Simplex-Virus (HSV) and in rare cases Ebstein-Barr-Virus (EBV).Because it is a rare but serious disease we reviewed a case series of all patients with an ARN since 2009 in a German university department of ophthalmology regarding to the status of the disease at the time when confirming the diagnosis and the outcome after 3 month, with the focus if vitrectomy was additionally performed.
The retrospective analysis included visual acuity (decimal) at first presentation and after 3 month, intraocular pressure (IOP), diagnostic findings, pathogen proof, therapy and common complications during treatment.
We included 10 patients (5 men, 5 women) with clinical signs of an ARN, 6 patients with bilateral affection, 3 of them with simultaneous onset of the disease and 3 with a latency of 1, 2 and 31 month, respectively. In 9 patients the pathogen was identified (5 VZV, 2 HSV, 1 CMV and 1 VZV/HSV). All patients were treated systemically and intravitreally with virostatic agents. In 9 eyes vitrectomy was additionally performed with a visual acuity of 0,2±0,2 at hospital admission, in 7 eyes with a visual acuity of 0,5±0,3 no vitrectomy was performed (p=0,04). After 3 month the vision of vitrectomized eyes was decreased to 0,1±0,1, the vision without vitrectomy was 0,4±0,3 (p=0,01). After 3 month, 2 vitrectomized eyes were hypotonic (IOP <10 mmHg). In total 6 of 16 eyes had a retinal detachment, of these 2 of 9 with and 4 of 7 without vitrectomy. The affection of the partner eye was always detected earlier (vision: 0,6±0,2 vs. 0,2±0,2) and was treated more successfully (vision: 0,4±0,3 vs. 0,1±0,1).
The progress of ARN is frequently combined with a relevant loss of vision. When the partner eye was affected, in all cases diagnosis could be confirmed earlier. Thus, faster and more successful treatment was possible. This is one reason why the use of vitrectomy cannot be evaluated definitively, because vitrectomy is more often indicated when the vision has severely decreased already. Early treatment with an appropriate approach is essential to sustain a good vision.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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