Acute Retinal Necrosis: Clinical Features, Diagnostic Pitfalls, Treatment, and Outcome of an Insidious Disease in Children. Case Report and Review of the Literature

Abstract

ObjectiveThis study aims to explore clinical features, diagnostic work-up, treatment, and outcomes of pediatric patients with acute retinal necrosis (ARN), and to propose a standardized management of this condition in childhood.MethodsClinical manifestations, diagnostic work-up, and treatment of three pediatric cases with ARN were analyzed. Furthermore, a review of the literature was performed from January 1990 to November 2021, focused on 1) clinical presentation; 2) differential diagnosis, including both infectious and non-infectious conditions; 3) key role of diagnostic techniques; and 4) currently available treatments.ResultsData from 72 children with ARN (69 from literature and 3 from our center) were analyzed. The most frequent presenting symptoms were red eye resistant to topical treatment (57%) and altered vision (58%), 25 patients had bilateral involvement. In 30% a known history of herpetic infection was reported. PCR testing on anterior chamber and/or vitreous sampling was performed in 46 cases (64%) and was diagnostic in 88% of them, with herpes simplex virus (HSV) 2 being the most frequently identified pathogen (57%). All patients underwent systemic antiviral therapy (16% only oral); adjunctive intravitreal injections were performed in 21% of them.ConclusionsARN is a rare but severe ocular infection presenting as a panuveitis with occlusive retinal vasculitis and peripheral retinal necrosis. Varicella-zoster virus and HSV 1–2 are most frequently implicated. Due to a high incidence of rhegmatogenous retinal detachment and optic atrophy, ARN has a poor prognosis with a potentially severe impact on visual function. Although a prompt recognition is crucial to prevent complications, ARN diagnosis in children is still challenging.

Diagnosis and Treatment of Uveitis in Children: A Summary of the Latest Data from a 5-Year Literature Review (2018–2023)

“…The most commonly reported complications from antiviral treatment with acyclovir in the general population include conjunctivitis, epitheliitis, uveitis, keratoconjunctivitis, corneal creeping ulcer, increased intraocular pressure, and swelling of the eyelids and face [ 64 ]. The most serious ocular complication of HSV infection in children is acute retinal necrosis [ 65 ]. Its characteristic clinical presentation includes rapidly progressive peripheral necrotizing retinitis, retinal and choroidal vasculitis, and vitreous body inflammation, facilitating preliminary diagnosis.…”

Herpetic Uveitis: An Experience from a Tertiary Referral Center in Bulgaria

“…The outcomes were worse in the panuveitis group, especially in the necrotizing variety (acute retinal necrosis), where BCVA at the end of the follow-up period was at most 20/100, which corresponds to other published reports. 9,10 The percentage of bilateral involvement was high. Retinal detachment, along with ocular hypertension, were the most frequent complications.…”

“…Retinal detachment, along with ocular hypertension, were the most frequent complications. 9,10 In all cohorts, the conservative treatment was carried out with antiviral medications -acyclovir or valaciclovir, alone or in combination with corticosteroids, as it has been recommended. 5,6 In one case, we also used systemic indomethacin.…”

Adaptive Optics of Kyrieleis Plaques in Varicella Zoster Virus-Associated Posterior Uveitis: A Multimodal Imaging Analysis

“…VZV uveitis can affect any segment of the eye. It can manifest with sight-threatening alterations including vitritis, retinal hemorrhages, vasculitis, retinitis and retinal necrosis [9][10][11]. While the diagnosis is based on the typical clinical and imaging findings, a polymerase-chain reaction (PCR) testing is often advised to confirm it.…”