Acute retinal necrosis: a case series with clinical features and treatment outcomes

Sims, Joanne L; Yeoh, Jonathan; Stawell, Richard

doi:10.1111/j.1442-9071.2009.02083.x

Cited by 66 publications

(99 citation statements)

References 10 publications

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“…4 In contrast, many studies have found that the overall rate of retinal detachment remains high even in eyes having undergone laser treatment. 4,8,23 Published reports have also suggested that eyes that do not receive laser are more likely to have extensive disease, consistent with a higher risk of retinal detachment. 22,23 Although there is ongoing debate, most reports suggest that prophylactic barrier laser should be attempted in cases where there is limited vitritis and the retina can be visualized.…”

Section: Discussionmentioning

confidence: 82%

“…4,8,23 Published reports have also suggested that eyes that do not receive laser are more likely to have extensive disease, consistent with a higher risk of retinal detachment. 22,23 Although there is ongoing debate, most reports suggest that prophylactic barrier laser should be attempted in cases where there is limited vitritis and the retina can be visualized. 4,22,23 Other treatments include systemic corticosteroids, although they have not been proven to improve visual outcomes.…”

Section: Discussionmentioning

confidence: 82%

“…22,23 Although there is ongoing debate, most reports suggest that prophylactic barrier laser should be attempted in cases where there is limited vitritis and the retina can be visualized. 4,22,23 Other treatments include systemic corticosteroids, although they have not been proven to improve visual outcomes. 22 Given that cytotoxic lymphocytes and other inflammatory cells are known to be involved in the destructive process in ARN, anti-inflammatory medication is thought to be an important component of treatment.…”

Section: Discussionmentioning

confidence: 99%

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Acute retinal necrosis (ARN) in the context of neonatal HSV-2 exposure and subconjunctival dexamethasone: case report and literature review

McGrath¹,

Woods²,

Lee³

et al. 2013

Digit J Ophthalmol

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SummaryHSV-2 is an important cause of the acute retinal necrosis (ARN) syndrome in younger patients. We describe an atypical case of HSV-2 ARN in the context of neonatal exposure and subconjunctival steroid injection. Clinicians should be aware of the association of neonatal or congenital exposure to HSV-2 as a risk factor for this disease because early treatment may improve outcome and/or avoid involvement of both eyes.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Acute retinal necrosis (ARN) in the context of neonatal HSV-2 exposure and subconjunctival dexamethasone: case report and literature review

McGrath¹,

Woods²,

Lee³

et al. 2013

Digit J Ophthalmol

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show abstract

“…Second eye involvement occurs in approximately a third of patients, typically within 6 weeks, although fellow eye involvement decades following an initial infection have been described [16]. The natural history of ARN is for 75% of affected eyes to progress to retinal detachment [17], the reported rate with intravenous acyclovir being reduced to 20-52% [7,[18][19][20][21]. Most retinal detachments occur within 6 months of presentation [20]: our patients had follow-up examinations longer than 6 months, suggesting that the risk of retinal detachment is significantly reduced.…”

Section: Discussionmentioning

confidence: 99%

Valacyclovir as a Therapeutic Agent in Acute Retinal Necrosis: Two Case Reports

T¹

2014

J Clin Res Ophthalmol

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Introduction: Acute retinal necrosis (ARN) is a rare, rapidly progressive viral retinitis. The current standard of care for ARN consists of intravenous acyclovir for 5-10 days, followed by oral acyclovir for an additional 6-12 weeks. Valacyclovir has superior plasma bioavailability to acyclovir as an oral preparation. The aim of this study is to add to the evidence of treating ARN with valacyclovir with 2 additional cases.Methods: 2 patients diagnosed with ARN received treatment with valacyclovir either as a monotherapy, or in combination with intravenous acyclovir.Results: All patients had significant improvement in visual acuity within 4 weeks of the initiation of treatment. In the sixth month follow-up none of them developed retinal detachment, which is one of the commonest sight-threatening complications of ARN. Conclusions:Valacyclovir proved effective at treating retinitis in both patients. The 2 g t.i.d. dose was well tolerated and neither patient developed systemic adverse effects associated with the treatment.treatment of varicella zoster acute retinal necrosis syndrome, with good anatomic and functional results [10].Valacyclovir and famciclovir have superior plasma bioavailability to acyclovir as oral preparations [11]. The aim of the present study is to add to this evidence with 2 additional cases of ARN treated with valacyclovir . Written informed consent was obtained from the patients for publication of these case reports and any accompanying images. Case Presentation Case report 1A 22-year-old white male was referred to our Department with a 1 day history of floaters and blurred vision in his right eye. His medical history was remarkable following a diagnosis of glandular fever 4 weeks previously. Additionally, 10 days prior to presentation the patient had presented to the Neurology Department with widespread macular pruritic rash, sore throat, nausea, fever, headache, unsteadiness, weakness on the left leg, and binocular diplopia. At that time serology had confirmed an acute EBV infection with increased titres for EBVIgM antibodies. Serological testing for Human Immunodeficiency Virus (HIV), hepatitis B and C, syphilis, HSV, VZV, and CMV was negative. A computerized tomography (CT scan) of the brain was unremarkable. However, analysis of cerebrospinal fluid (CSF) had revealed 97% lymphocytic cells, a protein level of 1.44 g/L and PCR had showed positive for HHV6 viral DNA (365 DNA copies/ mL). CSF testing for HSV, VZV, EBV, CMV, and enterovirus was negative. In this setting, the patient had been diagnosed with HHV6 encephalitis and left fourth 4th nerve palsy. He had been admitted under neurological care and treated with intravenous acyclovir (1 g 3 times daily for 10 days) and pulsed intravenous methylprednisolone (1g daily for 3 days).

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“…4 Today, ARN is recognized as being predominantly caused by varicella zoster virus (VZV) and herpes simplex virus types 1 and 2 (HSV-1, HSV-2), with some studies implicating cytomegalovirus (CMV) and Epstein-Barr virus (EBV). [4][5][6][7][8][9] While the diagnosis of ARN is usually straightforward, much controversy surrounds its management. Debate continues on the benefit or otherwise of aspirin, corticosteroids, barrier laser and prophylactic vitrectomy.…”

Section: Introductionmentioning

confidence: 99%

Antiviral selection in the management of acute retinal necrosis

Tam

Hooper²,

Lightman

2009

OPTH

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Abstract:There is no consensus on the optimal antiviral regimen in the management of acute retinal necrosis, a disease caused by herpetic viruses with devastating consequences for the eye. The current gold standard is based on retrospective case series. Because the incidence of disease is low, few well-designed, randomized trials have evaluated treatment dosage and duration. Newer oral antiviral agents are emerging as alternatives to high-dose intravenous acyclovir, avoiding the need for inpatient intravenous treatment. Drug resistance is uncommon but may also be difficult to identify. Antiviral drugs have few side effects, but special attention needs to be paid to patients who have underlying renal disease, are pregnant or are immunocompromised.

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Acute retinal necrosis: a case series with clinical features and treatment outcomes

Abstract: Acute retinal necrosis still has poor visual prognosis. Early diagnosis and initiation of treatment may improve outcome.

Cited by 66 publications

References 10 publications

Acute retinal necrosis (ARN) in the context of neonatal HSV-2 exposure and subconjunctival dexamethasone: case report and literature review

Acute retinal necrosis (ARN) in the context of neonatal HSV-2 exposure and subconjunctival dexamethasone: case report and literature review

Valacyclovir as a Therapeutic Agent in Acute Retinal Necrosis: Two Case Reports

Antiviral selection in the management of acute retinal necrosis

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