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LONG-TERM FOLLOW-UP OF ACUTE RETINAL NECROSIS

MEGHPARA, BEERAN MD; SULKOWSKI, GREGORY MD; KESEN, MUGE R. MD; TESSLER, HOWARD H. MD; GOLDSTEIN, DEBRA A. MD

doi: 10.1097/IAE.0b013e3181c7013c
Original Articles
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Purpose: The purpose of this study was to report long-term visual outcome of acute retinal necrosis.

Methods: Medical records of patients with acute retinal necrosis were reviewed.

Results: Thirty-two patients were diagnosed with acute retinal necrosis from 1998 to 2007. Twenty patients (25 eyes) had at least 1 follow-up and available medical records. Intravitreal injections of ganciclovir and/or foscarnet were administered in 11 of 25 eyes. Intravenous and oral antiviral medications were used in 14 of 20 and 19 of 20 patients, respectively. Eleven of 25 eyes had <25% of retina affected, 8 of 25 had 25% to 50% of retina affected, and 6 of 25 had >50% of retina affected. Mean visual acuity at all time points was best when retinitis involved <25% and decreased as area increased. All but 1 eye with >50% involvement experienced decreased vision regardless of treatment. Three of 4 eyes with 25% to 50% involvement that received intravitreal antivirals had an improvement in visual acuity of ≥2 Snellen lines. Five of 25 eyes developed retinal detachment. None of the six eyes treated with prophylactic laser detached.

Conclusion: Greater extent of retinitis portends a worse visual prognosis. Although intravitreal treatment did not prevent visual acuity loss in patients with severe disease, patients with moderate disease (25-50% retina involved) did well with intravitreal therapy with most having stable or improved visual acuity. Prophylactic laser decreased the rate of detachment.

Greater extent of retinitis portends a worse prognosis in patients with acute retinal necrosis. Patients with >50% retinal involvement had a poor prognosis regardless of treatment. Those with moderate disease did well with intravitreal therapy with stabilization or improvement of vision. Prophylactic laser treatment decreased the risk of retinal detachment.

From the Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois.

Supported by unrestricted grant from Research to Prevent Blindness, New York, New York.

None of the authors of this article have a proprietary interest.

Reprint requests: Debra A. Goldstein, MD, 1905 West Taylor Street, Chicago, IL 60612-3731; e-mail: debrgold@yahoo.com

© The Ophthalmic Communications Society, Inc.