Clinical profile and treatment outcomes in acute retinal necrosis in a South Indian patient population

To look at the clinical profile, treatment methods, and outcomes in cases of acute retinal necrosis (ARN) from a tertiary eye care center.

Hospital-based retrospective observational study wherein cases of ARN presented between January 2016 and December 2023 were reviewed. Demographic details, clinical presentation, complications, management, and visual outcome were evaluated.

Twenty eyes of 18 cases were included in the study. Mean age was 40.77 ± 16.38 years, male to female ratio was 2:1, and 11.11% had bilaterality at presentation. Mean duration of uveitis was 3.312 ± 0.95 months. The most commonly found organism was VZV (50%), followed by HSV (45%). All cases were given intravitreal ganciclovir in addition to systemic antivirals and oral steroids. The mean number of intravitreal injections was 5.53 ± 3.87. Maintenance dose of oral valacyclovir (500 mg twice daily) was continued in all cases for an average duration of 5.61 ± 3.79 months. The most common complications noted were retinal detachment (50%) followed by optic atrophy (44.44%). No significant association was noted between the extent of retinitis and the development of complications ( P = 0.215). However, there was a significant difference seen in the rate of complications between the HSV and VZV groups, with more complication rates seen with the VZV group ( P = 0.04). The mean visual acuity was 0.87 ± 0.85 logMAR at presentation and 0.65 ± 0.67 logMAR at the end of the study.

Timely diagnosis, aggressive initial treatment with intravitreal ganciclovir along with systemic antivirals and long-term maintenance therapy with systemic antivirals are crucial in ARN to obtain the best visual prognosis achievable and prevent lifelong disabilities.