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Acute Aggressive Posterior Progressive Necrotising Retinitis: Re-Evaluating Progressive Outer Retinal Necrosis
Akshita Aggarwal1,2, Spoorti Mandadi2,3, Avinash Pathengay4
1Standard Chartered - Academy for Eye Care Education, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India.
Purpose:
The aim of this paper is to describe and analyse the retinal involvement and Optical Coherence Tomography (OCT) findings in Progressive Outer Retinal Necrosis (PORN) and revisiting its terminology.
Methods:
Retrospective review of 26 eyes of 15 HIV-positive patients diagnosed with PORN. Cases were confirmed based on history, clinical features, and OCT imaging. Patients with media opacities were excluded. Clinical records, retinal fundus photography images and serial OCT images were reviewed from initial presentation to final follow-up. Retinal changes, extent and layers of retinal involvement and other OCT features of eyes diagnosed as PORN were analysed.
Results:
OCT findings revealed that 61.5% of eyes exhibited increased inner retinal thickness, while 69.2% demonstrated hyperreflectivity of the inner retinal layers at initial presentation, both of which resolved over time. The outer retinal layers remained structurally intact initially but showed full-thickness necrosis in advanced cases. OCT findings indicate that inner retinal involvement preceded outer retinal necrosis.
Discussion:
As the retinal necrosis originates in the inner retina and progresses towards the outer retina, OCT and histopathological evidence suggest that "Progressive Outer Retinal Necrosis" is a misnomer. The term "Acute Aggressive Posterior Progressive Necrotising Retinitis" is a more accurate term that characterizes the disease pathophysiology.
