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Published on: April 15, 2014
Outcomes of Patients with Acute Retinal Necrosis (ARN) presenting to a Canadian tertiary care centre: a 5-year
Cody Lo1,2, Jeffrey M Mah3, Carol Tadrous4
1Department of Ophthalmology, Faculty of Medicine, University of Ottawa, Box 307 , Ottawa, ON, K1H 8L6, Canada. codylomd@gmail.com.
Purpose:
To describe the contemporary management and outcomes of patients with acute retinal necrosis (ARN) at a tertiary Canadian hospital over a 5-year period.
Methods:
This was a retrospective cohort study of patients who presented to The Ottawa Hospital (Ottawa, Canada) and were newly diagnosed with ARN between January 2019 and July 2024. Data regarding demographics, clinical presentation, investigations, treatment, and outcomes were collected. The primary outcome was retinal detachment. Secondary outcomes were severe vision loss and other complications associated with ARN. Statistical analyses were performed to identify factors associated with develop of the primary and secondary outcomes.
Results:
A total of 16 eyes amongst 14 patients met inclusion criteria. The mean age at presentation was 56 years old, with 57% male. 5 patients (36%) had a known history of previous systemic herpetic infection. The most common exam findings on presentation were anterior chamber cell (94%), keratitic precipitates (88%), vitritis (94%), and arteritis (75%). Aqueous humor serology was positive for 96% of eyes (56% for VZV and 40% for HSV). Eyes received an average of 5.8 injections (range 1 to 17) of intravitreal antiviral therapy. Corticosteroids were administered in 13 patients (81%). Prophylactic laser retinopexy was used in 1 eye (6%) and pars plana vitrectomy was done for vitreous opacities in 1 eye (6%). During a mean follow-up of 424 days, 44% of eyes developed retinal detachment. The average time from symptom onset to diagnosis of retinal detachment was 105 days (range 14 to 180). Half of eyes had a final visual acuity worse than 20/200. The most common complications were cataract (38%) and recurrent anterior uveitis (31%). Initial BCVA of worse than 20/400 was significantly associated with an outcome of severe vision loss. No associations were found for development of retinal detachment.
Conclusion:
Our cohort demonstrates the range of presentations and outcomes in the management of ARN. While early recognition and systemic antivirals remain essential, our centre uses a larger number of intravitreal antiviral injections with less prophylactic laser or vitrectomy to achieve similar outcomes as other cohorts. This study highlights the value of standardized protocols for recognition and treatment of ARN.
