Clinical features and outcomes of Rhegmatogenous Retinal Detachments in Acute Retinal Necrosis

Rhegmatogenous retinal detachments (RRD) are the most common and sight-threatening complication of acute retinal necrosis (ARN). This study aims to analyze the clinical characteristics, treatment outcomes, and factors influencing RRD outcomes in ARN patients.

A retrospective review of ARN and ARN-related RRD cases diagnosed between 2014 and 2023 at a tertiary eye institute in South India was conducted. Data on demographics, clinical presentation, quadrant involvement, visual acuity, treatment modalities, outcomes, and RRD recurrence patterns were analyzed.

Among 322 ARN patients, RRD was observed in 111 eyes (27.32%) of 88 patients, with a mean age of 38 years and a male predominance (63%). HIV positivity was noted in 11.38%. Despite prophylactic photocoagulation in 17 eyes, RRD developed in 15 eyes within 2 months to 2 years. Silicone oil tamponade was used during primary surgical intervention, with 1000 cc in 77 eyes and 5000 cc in 34 eyes. RRD recurrence occurred in 42.6%. Multivariate analysis revealed significant associations between RRD recurrence and factors such as RRD at presentation or extensive retinitis involvement (over 50% of quadrants affected). Among the patients with recurrent RRD, roughly half (50%, n = 18) had involvement of over 50% retinal quadrants by ARN, and over half (71.42%, n = 35) presented with RD initially.

This study underscores the high prevalence of RRD in ARN. Retinal detachment at initial presentation and retinitis involving more than two quadrants were significant risk factors for RRD recurrence. Prophylactic laser photocoagulation did not prevent RRD occurrence.