Abstract

SO.20.13

Acute retinal necrosis

Winterhalter S.¹, Althaus C.², Stammen J.¹, Schöler E.¹, Joussen A.^1
1Universitäts-Augenklinik Düsseldorf; ²Augenklinik Ahaus

Objective: Acute retinal necrosis (ARN), caused by Herpes viruses, is a rare entity that mostly leads to poor visual outcome.
Methods: Thirteen patients with ARN were seen from 1991 untill 2006. Diagnosis was based on the Standard Diagnostic Criteria for the Acute Retinal Necrosis Syndrome of the American Uveitis Society and PCR of aqueous or vitreous taps. Patients were treated with intravenous Acyclovir/ Foscarnet, intravitreal injections of Foscarnet and oral steroids depending on clinical course and treatment response. Prophylactic photocoagulation was performed if possible. Complicating retinal detachment was managed with pars plana vitrectomy, silicone oil endotamponade and endolaser. Patient histories were serched for bilaterality, immunosuppression, PCR virus prove, clinical course and final visual acuity.
Results: Four females and 9 males were treated 29 to 77 years old. Five patients (38,5%) were immunocompromized. Diagnosis was made on clinical signs only in 6 patients. PCR examination achieved positive results in 5/7 patients (71%) with two positiv for VZV and one for HSV2. Three patients (19%), had a bilateral course of disease, 2 of these were immunocompromized. All patients were treated with i.v. Acyclovir and 2 patients with additional intravitreal injections of Foscarnet. Although prophylactic photocoagulation was performed 5/7 patients (71%) progressed to retinal detachment with in total retinal detachment in 8 eyes from 7 patients (50%). Total mean VA was measured with 0,5 log MAR (nulla lux to –0,1 log MAR). Final VA remained below reading ability in 12 eyes (75%). Immunocompromized patients showed a lower mean VA (0,9 log MAR) than immunocompetent (0,3 log MAR). Arteriitis, retinal with macula detachment, macula edema and optic atrophy explained VA below 1,0 log MAR (8 eyes, 50%).
Conclusions: Immunocompromized background and complications lead to poor visual outcome in ARN. Early diagnosis through PCR is recommended to improve medical management and decrease disease progression and complications.

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