Acute Retinal Necrosis: Signs, Treatment, Complications and Outcome

Abstract

Background: The Acute Retinal Necrosis (ARN) is an inflammatory, rapidly progressive necrotizing retinitis and vasculitis, most frequently caused by Varicella-Zoster-Virus (VZV), followed by Herpes-Simplex-Virus (HSV), Cytomegalovirus (CMV) and Epstein-Barr-Virus (EBV). The diagnosis is based on clinical signs that were first defined by the American Uveitis Society in 1994 that include one or more foci of retinal necrosis, rapid progression without treatment, circumferential progression, occlusive vasculopathy, and inflammatory signs of the vitreous and anterior chamber Methods: In this retrospective analysis, we included 16 eyes of 10 patients, six patients with simultaneous or delayed bilateral affection, treated for ARN. Status of disease, corrected distance visual acuity (CDVA, decimal), intraocular pressure (IOP), pathogen proof, therapy, and complications were evaluated at diagnosis and 3 months later. Results: In nine patients, the pathogen was identified (six VZV, two HSV, one CMV, one EBV). All patients were treated with systemic and intravitreal virustatic agents. In nine eyes with a CDVA of 0.2 ± 0.2 at hospital admission, vitrectomy was performed, and in seven eyes with CDVA of 0.5 ± 0.3, no vitrectomy was performed (p = 0.04). After 3 months, CDVA of the vitrectomized eyes decreased to 0.1 ± 0.1 vs. 0.4 ± 0.3 (p = 0.01) without vitrectomy. CDVA of fellow eyes affected was 0.6 ± 0.2 at initial presentation vs. 0.2 ± 0.2 for eyes affected first and 0.4 ± 0.3 vs. 0.1 ± 0.1 after 3 months. We observed several complications including retinal detachment, recurrence of the disease, and bulbar hypotony. Conclusion: For fellows eyes affected, diagnosis could be confirmed earlier, leading to a more successful treatment. The success of vitrectomy is difficult to evaluate because vitrectomy is most frequently performed just in the advanced stages of the disease. Early treatment with an appropriate approach is essential to avoid loss of vision.

Unveiling the Causal Link of herpes virus infection and Cutaneous Leukocytoclastic Angiitis: Insights from Mendelian Randomization

“…Various studies have explored the connection between the herpesvirus family and different types of angiitis. For example, EBV may be associated with anti-neutrophil cytoplasmic antibody-associated angiitis (AAV), Henoch-Schönlein purpura (HSP) and systemic vasculitis, varicella zoster virus causes giant cell arteritis, Acute Retinal Necrosis (ARN) and lgA angiitis, HSV infection is linked to cerebrovascular disease, and CMV infection can cause skin necrotizing angiitis (4,6,(27)(28)(29)(30)(31) . However, our MR analysis did not find a causal relationship between these viruses and CLA.…”

Herpes Zoster Ophthalmicus: Presentation, Complications, Treatment, and Prevention

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Fig. 3 Progression over time and complications of herpes zoster ophthalmicus [ 29 , 41 , 48 , 53 , 54 , 56 , 59 , 82 ]. IOP intraocular pressure, HZO herpes zoster ophthalmicus

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“…Although no data are available from randomized trials to guide management, immediate treatment of acute retinal necrosis with IV acyclovir followed by oral therapy to complete a 3- to 4-month course of antiviral treatment has been recommended to arrest viral replication and prevent the involvement of both eyes [ 70 , 80 , 81 ]. Intravitreal antiviral agents (foscarnet, ganciclovir) have also been recommended [ 29 , 82 ]. For optic neuropathy or orbitopathy, IV acyclovir is used at a dosage of 10–15 mg/kg three times daily for 2–3 weeks.…”

Analysis of the effect of health education model based on BCW theory in patients with acute retinal necrosis

“…ARN, a potentially blinding ocular disease with progresses rapidly, requires a high degree of attention [10]. Despite substantial breakthroughs in the diagnosis and treatment of ARN, the prognosis for patients with ARN remains poor, as indicated by the long duration of the disease, the complexity of treatment, and the loss of somatic function, resulting in a sense of disease uncertainty [11]. In this study, the scores of all dimensions of MUIS were decreased in the observation group after the intervention compared with that in the control group, and the difference was statistically significant, which…”