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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.
Seminars in Ophthalmology
|December 30, 2025
Summary
Progressive Outer Retinal Necrosis (PORN) involves inner retinal changes before outer retinal necrosis, challenging the condition's name. Optical Coherence Tomography (OCT) findings suggest a new, more accurate term is needed.
Area of Science:
- Ophthalmology
- Retinal Diseases
- Medical Imaging
Background:
- Progressive Outer Retinal Necrosis (PORN) is a severe retinal condition primarily affecting immunocompromised individuals.
- Accurate terminology is crucial for understanding disease progression and guiding treatment.
Purpose of the Study:
- To analyze retinal involvement and Optical Coherence Tomography (OCT) findings in PORN.
- To re-evaluate the terminology used for PORN based on observed pathophysiology.
Main Methods:
- Retrospective review of 26 eyes from 15 HIV-positive patients diagnosed with PORN.
- Analysis of clinical features, retinal fundus photography, and serial OCT images.
- Exclusion of cases with media opacities.
Main Results:
- OCT revealed inner retinal thickening and hyperreflectivity in most cases, which resolved over time.
- Outer retinal layers were initially intact but showed necrosis in advanced stages.
- Evidence indicates inner retinal involvement precedes outer retinal necrosis.
Conclusions:
- The term "Progressive Outer Retinal Necrosis" (PORN) appears to be a misnomer based on OCT and histopathological findings.
- "Acute Aggressive Posterior Progressive Necrotising Retinitis" is proposed as a more accurate descriptor of the disease's inner-to-outer retinal progression.
