Bilateral acute retinal necrosis. Clinical and ultrastructural study

Area of Science:

• Ophthalmology
• Immunology
• Electron Microscopy

Background:

• Acute retinal necrosis (ARN) is a severe intraocular inflammatory condition.
• ARN can lead to necrotizing retinitis, retinal vasculitis, and panuveitis.
• Immune system involvement is suspected in ARN pathogenesis.

Observation:

• A 28-year-old male presented with bilateral ARN, panuveitis, necrotizing retinitis, and vasculitis.
• Severe vitreous traction led to bilateral giant retinal tears and retinal detachment.
• Despite surgical intervention, both eyes experienced inoperable retinal detachment.

Findings:

• Vitreous aspirate showed numerous lymphocytes, and serum complement levels were depressed, suggesting an immune mechanism.
• Electron microscopy revealed preretinal membranes in the rhegmatogenous retinal detachment.
• These membranes were identified as originating from the retinal pigment epithelium.

Implications:

• This is the first electron microscopic evidence linking retinal pigment epithelium to preretinal membrane formation in ARN-associated retinal detachment.
• Understanding the source of these membranes may inform future treatment strategies for complex retinal detachments.
• The findings highlight the potential role of immune dysregulation in the severe ocular manifestations of ARN.