Acute retinal necrosis: clinical features, management and outcomes.

PURPOSE: To evaluate the clinical features, treatment, and visual outcome of patients with acute retinal necrosis (ARN). METHODS: The data of patients were retrospectively reviewed. Factors associated with visual loss and factors affecting the risk for retinal detachment (RD) development were evaluated. RESULTS: Twenty-four eyes of 24 patients (7 female/17 male, mean age 43.7 years, mean follow-up period 31.0 months) were included. In ocular fluid samples of 15 (83%) out of 18 eyes, polymerase chain reaction (PCR) tests were positive for herpes simplex virus (seven eyes; 39%), varicella zoster virus (six eyes; 33%), cytomegalovirus (one eye; 6%), and adenovirus (one eye; 6%). Central retinal occlusive vasculitis was observed in three (13%) eyes. Systemic antiviral therapy was given to all patients, and additional intravitreal ganciclovir was administered in seven eyes (29%). The most common complication was RD (46%). There was no statistically significant difference in the frequency of RD between herpes simplex virus- and varicella zoster virus-positive patients (p = .617). The rate of RD was similar in eyes undergoing prophylactic laser photocoagulation (LPC), eyes undergoing vitrectomy + LPC, and eyes not undergoing LPC (p = .237). The number of eyes with final visual acuity below 20/200 was significantly higher in eyes with RD than without RD (p = .047). CONCLUSION: Prophylactic LPC and vitrectomy did not show clear benefits in terms of preventing RD development. RD was the most common complication and a major factor for a poor visual prognosis.

Bilateral Necrotizing Retinitis following Encephalitis Caused by the Pseudorabies Virus Confirmed by Next-Generation Sequencing.

Purpose: The objective of this study was to report a case of bilateral necrotizing retinitis following viral encephalitis caused by the pseudorabies virus.Case report: A 49-year-old male had decreased bilateral visual acuity after the recovery of consciousness for one month. He had been in an unconsciousness status due to encephalitis for two months before the ocular symptoms developed. He was a pig slaughterer. Ocular ultrasound showed bilateral vitreous haze and retinal detachment. A vitrectomy and silicone oil tamponade were performed on the left eye. During surgery, massive periphery retinal necrosis appearing as a tattered fish net, and multiple retinal holes were observed. The pseudorabies virus was detected by next-generation sequencing in the vitreous specimen.Conclusion: The pseudorabies virus may cause bilateral necrotizing retinitis following viral encephalitis among those with close contact to pigs. Intraocular fluid provides a greater selection of samples and a longer time window for pathogenic detection.

[Acute retinal necrosis caused by varicella zoster virus]. / Ostryi nekroz setchatki, vyzvannyi virusom opoyasyvayushchego gerpesa.

Incidence of Herpes Zoster is relatively high. Herpes zoster ophthalmicus is one of the most common forms of the disease. Necrotising herpetic retinopathies (including acute retinal necrosis) are rare and usually these complications are presented in literature as individual cases. However, necrotising herpetic retinopathy can lead to complete loss of visual. The article reviews modern data on causation, diagnosis and treatment of acute retinal necrosis analyzing 40 open access articles from EBSCO published in 2011-2019, and describes the modern views on the prevalence and most important clinical features of herpetic acute retinal necrosis. Some contradictory opinions have been revealed concerning the diagnostic criteria and surgical treatment of acute retinal necrosis.

Acute retinal necrosis by herpes simplex virus type 1: an unusual presentation of a primary infection.

Herpes simplex virus (HSV) can affect the central nervous system causing meningitis, encephalitis and, rarely, acute retinal necrosis. We present a case of a 46-year-old man, previously healthy complaining of a 5-day persistent headache and sudden loss of vision of his left eye that progressed to the right. We started ceftriaxone, methylprednisolone and acyclovir for suspected encephalitis with vasculitis. HSV-1 was identified in vitreous and aqueous humour. Therapy with acyclovir was maintained and two intravitreous boluses of foscarnet were administered, without improvement. Usually being a benign infection, HSV can, in rare cases like this, have catastrophic effects in the optic tract.

Human encephalitis complicated with bilateral acute retinal necrosis associated with pseudorabies virus infection: A case report.

We report the case of a patient who presented with viral encephalitis and a pulmonary infection complicated with bilateral acute retinal necrosis after direct contact with diseased swine. Next-generation sequencing of the cerebrospinal fluid and vitreous humor detected pseudorabies virus (PRV) simultaneously. Intravenous acyclovir and dexamethasone treatment improved the symptoms of encephalitis, and vitrectomy surgery with silicone oil tamponade was used to treat the retinal detachment. This case implies that PRV can infect humans; thus, self-protection is imperative when there is contact with animals.

Bilateral Acute Retinal Necrosis: Clinical Features and Outcomes in a Multicenter Study.

Purpose: To describe clinical features and outcome in bilateral acute retinal necrosis (BARN). Methods: Observational retrospective longitudinal review of ocular findings. Results: Thirty eyes of 15 patients (age 44.1 ± 15.8). Delay of involvement between eyes was 57.2 ± 105.2 months (median 3, range 0.5-360). Herpes simplex virus (HSV)-1 was the most frequent (20 eyes, 66.6%), followed by HSV-2 (five eyes, 16.7%) and varicella zoster virus (VZV, four eyes, 13.3%). Visual acuity worsened in 7 (23%) eyes, improved in 4 (13%), and remained stable in 19 (63%). Major complications included retinal detachment (11 eyes, 36%), optic atrophy (11 eyes, 33%), proliferative vitreoretinopathy (four eyes, 13.3%), neovascular glaucoma (four eyes, 13.3%), phthisis bulbi (three eyes, 10%). Symptoms-to-referral average time was 2.7 ± 1.0 weeks (range 1-4). Conclusions: In our study BARN was associated with severe visual outcome and high rate of ocular complications. Although BARN is a rare disease, the course is aggressive, regardless prompt referral in tertiary-care uveitis centers.

[Research progress on the diagnosis and treatment of acute retinal necrosis].

Acute retinal necrosis is an uncommon but devastating and potentially blinding ophthalmopathy featured with unfavorable prognosis as the lesions tend to develop rapidly in a circumferential way in few days. Therefore timely diagnosis and early treatment are of great significance. The polymerase chain reaction test on intraocular fluid can improve specificity and sensitivity of the etiological detection for acute retinal necrosis. Etiology results included in the diagnostic criteria is favorable for etiological diagnosis. Current treatment for acute retinal necrosis is generally based on systemic antiviral therapy, and supported by hormone and antithrombotic drugs, while surgical treatment should be considered when the disease progresses. This article reviews the research progress on the diagnosis and treatment of acute retinal necrosis in an effort to improve the diagnosis and treatment performance of acute retinal necrosis. (Chin J Ophthalmol, 2018, 54: 306-311).

Diagnosis and Treatment of Acute Retinal Necrosis: A Report by the American Academy of Ophthalmology.

PURPOSE: To evaluate the available evidence in peer-reviewed publications about the diagnosis and treatment of acute retinal necrosis (ARN). METHODS: Literature searches of the PubMed and Cochrane Library databases were last conducted on July 27, 2016. The searches identified 216 unique citations, and 49 articles of possible clinical relevance were reviewed in full text. Of these 49 articles, 27 were deemed sufficiently relevant or of interest, and they were rated according to strength of evidence. An additional 6 articles were identified from the reference lists of these articles and included. All 33 studies were retrospective. RESULTS: Polymerase chain reaction (PCR) testing of aqueous or vitreous humor was positive for herpes simplex virus (HSV) or varicella zoster virus (VZV) in 79% to 100% of cases of suspected ARN. Aqueous and vitreous specimens are both sensitive and specific. There is level II and III evidence supporting the use of intravenous and oral antiviral therapy for the treatment of ARN. Data suggest that equivalent plasma drug levels of acyclovir can be achieved after administration of oral valacyclovir or intravenous acyclovir. There is level II and III evidence suggesting that the combination of intravitreal foscarnet and systemic antiviral therapy may have greater therapeutic efficacy than systemic therapy alone. The effectiveness of prophylactic laser or early pars plana vitrectomy (PPV) in preventing retinal detachment (RD) remains unclear. CONCLUSIONS: Polymerase chain reaction testing of ocular fluid is useful in supporting a clinical diagnosis of ARN, but treatment should not be delayed while awaiting PCR results. Initial oral or intravenous antiviral therapy is effective in treating ARN. The adjunctive use of intravitreal foscarnet may be more effective than systemic therapy alone. The role of prophylactic laser retinopexy or early PPV is unknown at this time.

[Clinical features of viral encephalitis with bilateral acute retinal necrosis syndrome].

OBJECTIVE: To explore the clinical features of viral encephalitis with acute retinal necrosis syndrome.
 Methods: Clinical symptoms, laboratory tests, treatment and prognosis for 6 patients with viral encephalitis and acute retinal necrosis syndrome, who admitted to Xiangya Hospital from October 2013 to March 2015, were retrospectively analyzed.
 Results: Clinical features of the six cases are similar. Anti-virus treatment and anti-inflammation therapy can improve the prognosis. 
 Conclusion: Viral encephalitis with acute retinal necrosis syndrome is common and the neurological physicians need to strengthen the understanding of this disease.

Acute retinal necrosis--a case report.

Acute retinal necrosis (ARN) is a rare but very severe form of retinitis. In contrast to progressive outer retinal necrosis acute retinal necrosis typically affects immunocompetent individuals. Herpes Simplex and Varicella-zoster viruses play the main role in the development of the disease. We report a case study of a healthy, young male who presented to the ophthalmologist with unilateral visual acuity decrease and eye irritation. The acute retinal necrosis was diagnosed and a therapy was started including both systemic and local anti-viral agents, as well as an oral anticoagulant. Additional systemic steroid therapy was introduced a week later. The regression of retinal inflammatory changes and the improvement of visual acuity were observed. The polymerase chain reaction assay for the presence of viral DNA in serum was negative. The IgM antibody assay for potential causal pathogens was negative, but the level of Varicella-zoster virus IgG antibodies was markedly elevated. During the follow-up, the patient developed retinal detachment and pars plana vitrectomy with silicone oil endotamponade was performed. Although the surgery resulted in the successful retinal reattachment, the final visual acuity remained decreased. Six months after the surgery, the eye was free of the intraocular inflammation and the visual acuity slightly improved.

Presumed bilateral acute retinal necrosis 11 years apart, atypical presentation, and early vitrectomy.

PURPOSE: To report a case of presumed bilateral acute retinal necrosis with delayed onset caused by herpes simplex virus type 2, medical treatment, and surgical approach. METHODS: Retrospective, interventional case described in a 51-year-old patient who complained of unilateral blurred vision with history of nonoperated retinal detachment in his fellow eye after posterior uveitis 11 years earlier. RESULTS: Ocular examination suggested diagnosis of acute retinal necrosis involving the posterior pole and sparing periphery. The causative agent was demonstrated using polymerase chain reaction analysis of the aqueous humor. Intensive medical treatment with intravenous acyclovir, intravitreous foscarnet, and corticosteroids was administered, slowing down but not stopping progression of the disease. Due to the monocular status of the patient and high probability of secondary retinal detachment, early vitrectomy was indicated. CONCLUSIONS: Rapid and aggressive medical treatment is necessary in this condition. Bilateral involvement often occurs within weeks, but can also happen more rarely after several months or years, requiring long-term follow-up. Early surgical treatment is controversial but it is an option to be considered in certain cases.

Necrosis retinal aguda vs. necrosis retinal externa progresiva: reporte de caso y revisión de la literatura / Acute retinal necrosis vs. progressive outer retinal necrosis: case report and literature review

Se describen las características principales de la necrosis retinal aguda, la relación fisiopatológica con su principal diagnóstico diferencial, la necrosis retinal externa progresiva. Exponemos las diferencias clínicas y paraclínicas de ambas enfermedades, con base en las cuales construimos un sistema de clasificación que las contempla como un espectro continuo de enfermedad dependiente del estado inmunológico.

The main characteristics of acute retinal necrosis, the pathophysiological connection with the main differential diagnosis and progressive outer retinal necrosis are described. We analize the clinical and paraclinical differences of both diseases, based on which we built a classifi cation system that take them into a continuous spectrum dependent of the immune state.

Acute retinal necrosis associated with Epstein-Barr virus: immunohistopathologic confirmation.

IMPORTANCE: Acute retinal necrosis (ARN) is an infectious retinitis primarily caused by the herpesviruses. Although the Epstein-Barr virus (EBV) has been implicated as a cause of ARN, to our knowledge, there has been no histopathologic documentation. We report the clinical history and histopathologic confirmation that EBV can cause ARN. OBSERVATIONS: Clinical course and histopathology of a patient diagnosed with ARN caused by infection with EBV confirmed by molecular pathology. CONCLUSIONS AND RELEVANCE: Epstein-Barr virus is a recognized cause of intraocular inflammation and has been implicated as a possible cause of ARN. However, to our knowledge, tissue demonstration of EBV in a patient with ARN has not previously been reported. We identified the organism in the necrotic retina of a patient receiving immunosuppression because of idiopathic pulmonary fibrosis.

Emerging concepts in the management of acute retinal necrosis.

Acute retinal necrosis (ARN), also known as Kirisawa-type uveitis, is an uncommon condition caused by infection of the retina by one of the herpes family of viruses, most typically varicella zoster virus or herpes simplex virus and less commonly cytomegalovirus. Clinical diagnosis can be challenging and is often aided by PCR-based analysis of ocular fluids. Treatment typically involves extended use of one or more antiviral agents. Long term retinal detachment risk is high. We review the literature on ARN and present an approach to the diagnosis and management of this serious condition.

Serpiginous choroiditis and acute retinal necrosis occurring in the same patient.

We describe a rare association of serpiginous choroiditis with necrotizing retinitis having clinical features of acute retinal necrosis (ARN). A 23-year-old male developed ARN in the fellow eye while he was on tapering doses of immunosuppressive medications for unilateral serpiginous choroiditis. The association may represent a common viral etiology of the two diseases or may be due to the development of ARN due to general state of iatrogenic immunosuppression. This report also highlights the importance of a detailed evaluation of both the eyes on regular follow-up visits in the patients receiving iatrogenic immunosuppression.