Incidence and clinical characterization of retinal detachment in acute retinal necrosis: a global federated database...

To determine the incidence of retinal detachment (RD) following acute retinal necrosis (ARN) and to evaluate demographic and treatment-related associations using a large, multi-institutional database. Design: Retrospective cohort study.

Setting: TriNetX Research Network. Study population: Patients diagnosed with ARN between January 1, 2014, and January 1, 2024. Procedures: ARN and RD were identified using ICD and CPT codes. Chi-square tests, risk ratio analyses, and logistic regression models were used to evaluate demographic and treatment-related associations of RD. Main outcome measures: Incidence and associations for RD at 3, 6, and 12 months post-diagnosis of ARN.

Among 1,785 patients with ARN, the overall incidence of RD was 12.49% (n=223), with 135 cases (60.5%) occurring within the first 3 months of diagnosis and 88 cases (39.5%) occurring thereafter. Although aggressive combination therapy consisting of systemic corticosteroids, oral valacyclovir, and/or intravitreal foscarnet was primarily used in severe cases, RD still occurred frequently. No significant differences were observed in RD incidence based on age, sex, diabetes status, or immunosuppression.

In this large EHR-based cohort, RD following ARN occurred most commonly within the first 3 months after diagnosis. Treatment exposures (corticosteroids, valacyclovir, intravitreal foscarnet) should be interpreted strictly as proxies of disease severity, not independent risk factors for RD. These findings underscore the importance of close ophthalmic monitoring during the first 3 months after ARN diagnosis, when the risk of RD is highest.