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Hiroshi Keino, Makiko Nakayama, Takayo Watanabe, Yoshimasa Ando, Takashi Koto, Kazunari Hirota, Makoto Inoue, Annabelle Okada; Decreased optic nerve head blood flow in acute retinal necrosis. Invest. Ophthalmol. Vis. Sci. 2019;60(9):876.
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© ARVO (1962-2015); The Authors (2016-present)
Acute retinal necrosis (ARN) is a devastating intraocular herpetic infection characterized by a progressive necrotizing retinitis, and as well as an ischemic vasculopathy due to retinal perivasculitis and vasculitis. The purpose of this study was to evaluate optic nerve head (OHN) blood flow changes over the course of treatment of ARN using laser speckle flowgraphy (LSFG).
To evaluate OHN blood flow levels, mean blur rate (MBR), which is representative of relative blood flow velocity, was measured by LSFG in affected and unaffected eyes of 7 consecutive patients (1 woman, 6 men) with unilateral ARN over follow-up.
The mean age of the patients was 59 years (35 – 88 years), and the mean follow-up was 29 months (18-40 months). Varicella zoster virus (VZV) was detected by polymerase chain reaction testing in aqueous humor samples from all patients. All patients received intravenous acyclovir and oral corticosteroid treatment. The mean ONH MBR in eyes with ARN was 13.6±3.3 at baseline (n = 7), 8.7±3.1 at 2 weeks (n = 7), 10.1±3.8 at 1 month (n = 6), 12.1±5.3 at 3 months (n = 6), and 11.5±5.5 at 6 months (n = 5), whereas the mean ONH MBR in unaffected eyes was 22.9±7.3 at baseline, 19.4±2.8 at 2 weeks, 18.7±2.3 at 1 month, 20.9±3.8 at 3 months, and 20.3±1.2 at 6 months. The mean ONH MBR was significantly reduced in eyes with ARN compared to unaffected eyes over follow-up. Mean MBR ratio (ARN eye/fellow eye) was 0.62±0.09 (baseline), 0.46±0.20 (2 weeks), 0.53±0.20 (1 month), 0.58±0.24 (3 months), and 0.57±0.31 (6 months). Four patients developed retinal detachment in the ARN-affected eye during follow-up period. The ONH MBR showed a downward trend in 4 eyes that developed retinal detachment, while the ONH MBR showed improvement in the other 3 cases without retinal detachment over follow-up. Best-corrected visual acuity (BCVA) in 4 eyes with retinal detachment was 20/200 or less, whereas BCVA in 3 eyes without retinal detachment was 20/20 at 12 months.
The present study demonstrates significant reduction of OHN blood flow velocity in affected eyes of ARN patients during follow-up period. Further investigations are required to delineate the clinical significance of compromised ONH blood flow in ARN.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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