Acute Retinal Necrosis: Clinical Features, Early Vitrectomy, and Outcomes

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• 作者：Jost Hillenkamp ; Bernhard Nö ; lle ; Claudia Bruns ; Peter Rautenberg ; Helmut Fickenscher ; Johann Roider
• 刊名：Ophthalmology
• 出版年：2009
• 出版时间：October 2009
• 年：2009
• 卷：116
• 期：10
• 页码：1971-1975.e2
• 全文大小：304 K

文摘

Objective

To determine the viral diagnosis and the outcome of eyes with acute retinal necrosis (ARN) treated with intravenous acyclovir and oral prednisolone alone or combined with early vitrectomy and intravitreal acyclovir lavage.

Design

Nonrandomized, retrospective, interventional, comparative, consecutive series.

Participants

A cohort of 27 human immunodeficiency virus–negative patients with ARN comprising 24 unilateral and 3 bilateral cases.

Intervention

Vitreous biopsy for viral diagnosis. Twenty eyes were treated with intravenous acyclovir in combination with oral prednisolone (group A). Ten eyes were treated additionally with early vitrectomy, intravitreal acyclovir lavage, laser demarcation of necrotic retinal areas when feasible—with or without scleral buckling, and gas or silicone oil tamponade (group B). Vitrectomy was performed in all cases of secondary rhegmatogenous retinal detachment (RD).

Main Outcome Measures

Results of vitreous biopsy, rate of RD, rate of phthisis bulbi, and course of best-corrected visual acuity (BCVA).

Results

Varicella zoster virus (VZV) was detected in 26 eyes, followed by herpes simplex virus (5 eyes), and Epstein-Barr virus (2 eyes, in conjunction with VZV). An RD developed in more eyes in group A (18 of 20 eyes) than in group B (4 of 10 eyes; P = 0.007). In 2 of 20 eyes in group A and in 0 of 10 eyes in group B, phthisis bulbi developed without a significant difference between groups A and B. Mean BCVA (logarithm of the minimum angle of resolution) at first visit was 1.09 (standard deviation [SD], 0.83), and mean final BCVA was 1.46 (SD, 0.88) without significant difference between groups A and B.

Conclusions

Varicella zoster virus is the leading cause of ARN. Visual prognosis is guarded. Early vitrectomy with intravitreal acyclovir lavage was associated with a lower incidence of secondary RD; however, it did not improve mean final visual acuity.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.