Long-term outcomes in patients undergoing vitrectomy for retinal detachment due to viral retinitis

Abstract

Purpose: To determine the outcomes in patients with rhegmatogenous retinal detachment (RRD) secondary to viral retinitis.

Patients and methods: This was a retrospective, consecutive, noncomparative, interventional case series of 12 eyes in ten patients with RRD secondary to viral retinitis. Results of vitreous or aqueous biopsy, effect of antiviral therapeutics, time to retinal detachment, course of visual acuity, and anatomic and surgical outcomes were investigated.

Results: There were 1,259 cases of RRD during the study period, with 12 cases of RRD secondary to viral retinitis (prevalence of 0.95%). Follow-up was available for a mean period of 4.4 years. Varicella zoster virus was detected in six eyes, herpes simplex virus in two eyes, and cytomegalovirus in two eyes. Eight patients were treated with oral valacyclovir and two patients with intravenous acyclovir. Lack of optic nerve involvement correlated with improved final visual acuity of 20/100 or greater. Pars plana vitrectomy (n=12), silicone-oil tamponade (n=11), and scleral buckling (n=10) provided successful anatomic retinal reattachment in all cases, with no recurrent retinal detachment and no cases of hypotony during the follow-up period.

Conclusion: Varicella zoster virus was the most frequent cause of viral retinitis, and lack of optic nerve involvement was predictive of a favorable visual acuity prognosis. Vitrectomy with silicone-oil tamponade and scleral buckle placement provided stable anatomical outcomes.

Keywords: acute retinal necrosis; herpetic retinitis; retinal detachment; viral retinitis; vitrectomy.

Figure 1

Fundus drawings. Notes: Preoperative rhegmatogenous retinal detachment (RRD) cases secondary to acute retinal necrosis with the surgical procedures superimposed. (A and B) 28 year-old female with bilateral rhegmatogenous retinal detachment (RRD). (C) 33 year-old male with RRD and optic nerve involvement. (D) 60 year-old male with RRD but no optic nerve involvement. (E and F) Macula-on RRD with optic nerve involvement. (G and H) 24 year-old male with bilateral RRD. (I) 75 year-old female with RRD. (J) 67 year-old female with macula-on RRD and optic nerve involvement. (K) 66 year-old female with macula-off RRD. (L) 60 year-old male with macula-off RRD. Abbreviations: OD, oculus dexter (right eye); OS, oculus sinister (left eye).

Figure 2

Acute retinal necrosis with macular and optic nerve involvement (case 5). Notes: (A) Preoperative color fundus photography of case 5 illustrates retinal whitening in the macula with peripheral retinal necrosis. There is optic nerve involvement, with disk hyperemia and edema. There is moderate vitritis with a macula-off rhegmatogenous retinal detachment. Presenting visual acuity was 20/800. (B) Postoperative color fundus photography 2 months after cataract extraction with placement of a posterior-chamber intraocular lens and 23-gauge pars plana vitrectomy with silicone-oil tamponade. Final visual acuity was “counts fingers”.

Figure 3

Macula-off rhegmatogenous retinal detachment secondary to acute retinal necrosis (case 3). Notes: (A) Preoperative color fundus photography of case 3 illustrates a macula-off rhegmatogenous retinal detachment with no posterior pole involvement, including no optic nerve involvement. Presenting visual acuity was 20/200. (B) Postoperative color fundus photography 1 week after 23-gauge pars plana vitrectomy with scleral buckle and silicone-oil tamponade. Final visual acuity was 20/30.