[Treatment results for acute retinal necrosis]

To investigate the clinical course of patients with acute retinal necrosis (ARN) in order to evaluate the efficacy of treatment.

Clinical characteristics, causative virus, treatment and clinical course were analyzed in 14 eyes of 14 patients with ARN who presented between December 2000 and April 2008.

All patients were treated with systemic anti-viral agents. Four eyes (29%) did not develop retinal detachment nor did they undergo prophylactic vitreous surgery; 3 of these eyes were of patients with baseline systemic diseases and were in a state of relative immunosuppression. Rhegmatogenous retinal detachment occurred in 6 eyes (43%) for which vitreous surgery with silicone oil tamponade was performed. Successful retinal reattachment was obtained in 5 of these eyes, although the silicone oil could not be removed in 3 eyes judged to be at high risk for recurrent detachment. Prophylactic vitreous surgery was performed in 3 eyes (21%) that had no retinal detachment. The indication for surgery in these eyes was an acute worsening of vitreous haze obscuring view of the fundus. Two of these eyes required a second surgical procedure, but all 3 eyes maintained useful vision with final attachment of the retina.

Good outcomes were obtained in ARN patients who at baseline were in a state of relative immunosuppression, suggesting a role for strong immune reactions in the development of retinal detachment in ARN. Silicone oil could not be removed in most eyes that had undergone vitreous surgery after the onset of retinal detachment. Indications for the use of prophylactic vitreous surgery for ARN eyes without retinal detachment require further evaluation.