Prediction of visual outcomes using ultra-widefield fundus imaging in patients with acute retinal necrosis.

Abstract

Purpose : Acute retinal necrosis (ARN) is a rapidly progressive disease with a poor visual outcome due to infection with varicella-zoster virus (VZV) or herpes simplex virus (HSV) -I or -2. This study examined the clinical factors associated with the visual outcome of acute retinal necrosis using ultra-widefield fundus imaging in a single referral center in Japan.

Methods : The retrospective study included 34 eyes of 34 patients with ARN (16 men and 18 women) who first visited at the Department of Ophthalmology, Kyushu University Hospital between April 2015 and March 2021. We reviewed the medical records including visual acuity at the initial and last visit and presence or absence of retinal detachment. Fundus imaging was performed using ultra-widefield fundus imaging Optos Daytona® to assess the extent of retinal exudates from posterior (zone 1) to peripheral (zone 3) according to the criteria of zone classification for cytomegalovirus retinitis proposed by Holland and the angles using OptosAdvance ® software. In the multivariate analysis, we included the following possible risk factors for poor vision: presence or absence of retinal detachment, zone classification, and angles of retinal exudates by 30°increment. We estimated the multivariate odds ratio (OR) and 95% confidence interval (CI) of each potential factor by using a logistic regression analysis. Poor vision defined as logMAR > 1.0.

Results : The mean age was 56.7 ± 17.0 years (10-85 years). The mean observation period was 30.3 ± 23.2 months. The mean logMAR was 0.71 ± 0.72 at the initial and 1.16 ± 0.81 at the last visit. 7 patients had retinal detachment at the initial visit. The zone classification was zone 1 (n = 5), zone 2 (n = 20), and zone 3 (n = 9). The average angles of retinal exudates were 249±115°. The logistic regression analysis revealed that subjects with angles of retinal exudates or visual acuity at the initial examination were associated with final poor vision, with an OR of 1.37 in range by 30°(95%Cl: 1.00-1.88, p = 0.02) and 5.39 in visual acuity at initial visit (95%Cl: 0.87-33.3, p = 0.03).

Conclusions : The range of retinal exudates utilizing ultra-widefield fundus imaging and visual acuity at the initial visit may be useful in predicting visual outcome.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.