Acute retinal necrosis syndrome: clinical manifestations and visual outcomes

In this paper we attempt to describe the clinical features, visual outcomes, and surgical results of patients with acute retinal necrosis (ARN) syndrome and elucidate the risk factors for a poor prognosis. We also review the methods of treatment.

This was a retrospective, noncomparative, observational study of patients diagnosed with ARN syndrome. Nine patients (11 eyes) in Chang Gung Memorial Hospital, Kaohsiung from January 1990 to December of 2002 were enrolled. Blood sera and vitreous specimens were analyzed. Necrosis locations and surgical results are described.

Bilateral involvement occurred in 2 of our 9 patients (2/9, 22.2%). There was no specific relationship between age and level of the serum virus antibody. All of our polymerase chain reaction data for herpes simplex virus were negative. All 6 eyes of 6 patients who underwent surgery for retinal detachment had partial retinal reattachment postoperatively. Overall, anatomic success was achieved in 8 eyes (8/11, 72.7%). The percentage of eyes with ambulatory visual acuity was 36.3% (4/11), and visual acuity was preserved in 27.3% (3/11) at the last visit.

We found that retinal necrosis which extended rapidly to the posterior pole was associated with a poor visual outcome. Eyes with less than grade II necrosis extension are good candidates for prophylactic peripheral retinal photocoagulation. Early detection and prompt treatment with acyclovir seems to improve the final visual outcome.