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. 2012 Mar;26(3):370-7; quiz 378.
doi: 10.1038/eye.2011.338. Epub 2012 Jan 27.

Acute retinal necrosis in the United Kingdom: results of a prospective surveillance study

T F Cochrane  1 , G Silvestri, C McDowell, B Foot, C E McAvoy
Affiliations

Acute retinal necrosis in the United Kingdom: results of a prospective surveillance study

T F Cochrane et al. Eye (Lond). 2012 Mar.

Abstract

Background: To determine the incidence of acute retinal necrosis (ARN) in the United Kingdom and to describe the demographics, management, and visual outcome in these patients.

Methods: This was a prospective study carried out by the British Ophthalmological Surveillance Unit (BOSU) between September 2007 and October 2008. Initial and 6-month questionnaires were sent to UK ophthalmologists who reported cases of ARN via the monthly BOSU report card system.

Results: In all, 45 confirmed cases (52 eyes) of ARN were reported in the 14-month study period, giving a minimum incidence of 0.63 cases per million population per year. There were 20 females and 25 males. Age ranged from 10 to 94 years. Eight patients had a history of herpetic CNS disease. Aqueous sampling was carried out in 13 patients, vitreous in 27, and cerebrospinal fluid (CSF) in 4. Varicella-zoster virus followed by herpes simplex were the most common causative agents. Treatment in 76% of the cases was with intravenous antivirals; however, 24% received only oral antivirals. In all, 47% of patients had intravitreal antiviral therapy. Visual outcome at 6 months was <6/60 in 48% of the affected eyes.

Conclusion: The minimum incidence of ARN in the UK is 0.63 cases per million. Patients with a history of herpetic CNS disease should be warned to immediately report any visual symptoms. There is increased use of oral and intravitreal antivirals in initial treatment.

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Figures

Figure 1
Figure 1
Acute retinal necrosis—peripheral retinal necrosis with discrete scalloped margin.
Figure 2
Figure 2
Distribution of ages of patients with ARN.
Figure 3
Figure 3
Viral DNA isolated from aqueous, vitreous, or CSF in patients with ARN (n=30).
Figure 4
Figure 4
Visual acuity at presentation vs visual acuity at 6 months in eyes with ARN.
See this image and copyright information in PMC

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