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Review
. 2024 Feb;193(1):509-516.
doi: 10.1007/s11845-023-03426-2. Epub 2023 Jun 27.

Treatment outcomes of PCR-positive acute retinal necrosis

Ahmad M Sidiqi  1 , Mahadev Bhalla  2 , Haaris M Khan  2   3 , Forson Chan  2 , Christopher Lowe  4 , Eduardo V Navajas  5   6
Affiliations
Review

Treatment outcomes of PCR-positive acute retinal necrosis

Ahmad M Sidiqi et al. Ir J Med Sci. 2024 Feb.

Abstract

Background: Acute retinal necrosis (ARN) is a progressive necrotizing retinitis caused by viral infection. Optimal management strategies have not been established for this detrimental disease. Previous literature published suggests that Varicella-zoster virus (VZV) and Herpes simplex virus-1 (HSV1) are the most common promoters of acute retinal necrosis (ARN).

Aims: The purpose of our study was to investigate the viral distribution, demographic, and treatment outcomes of ARN.

Methods: A retrospective chart review evaluated data from PCR-positive ARN patients diagnosed between 2009 and 2018.

Results: Analysis of fourteen eyes from 12 patients found CMV and VZV as the commonest causes of ARN. Patients on 1 g of valacyclovir three times a day (V1T) had worse vision between first and final visits (mean difference of 1.25 ± 0.65, n = 2) compared with patients treated with 2 g of valacyclovir three times a day (V2T), or 900 mg twice a day of valganciclovir (V9B) (mean difference of - 0.067 ± 0.13, n = 6, and 0.067 ± 0.067, n = 6, respectively). Both V1T patients developed retinal detachments (RD). Both CMV patients treated with intravitreal triamcinolone developed ARN, elevated IOP, and one developed multiple RD.

Conclusions: Our review found increased incidence of CMV-positive ARN. Patients with zone 1 disease had worse initial visual acuity. Moreover, patients had more favorable outcomes with V2T and V9B compared to V1T. CMV-positive patients clinically worsened after intravitreal steroid injections, further underscoring the value of a PCR diagnosis to tailor the patients' treatment plan accordingly.

Keywords: Infectious disease; Panuveitis; Retinitis; Uveitis; Vitritis.

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References

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