The necessity and optimal time for performing pars plana vitrectomy in acute retinal necrosis patients

Abstract

BackgroundTo compare the efficacy of pars plana vitrectomy (PPV) at different time points to treat acute retinal necrosis (ARN) and to investigate the necessity of PPV for ARN.MethodsA retrospective review of the treatment options and outcomes of the ARN patients was performed. Thirty ARN patients (34 eyes) were included in this study. The eyes were divided into 3 groups depending on the treatment administered. In the medically treated group, there was no retinal detachment (RD) at the first visit. The routine group patients were treated with systemic antiviral medications, as well as with intravitreal antiviral injections. In the early PPV treatment group, there was no RD at the first visit. The early PPV treatment group patients were treated with systemic antiviral medications and PPV plus silicone oil tamponade and intravitreal injection. In the PPV group, there was RD at the first visit. The PPV group patients were treated with systemic antiviral medications and PPV plus silicone oil tamponade and intravitreal injection.ResultsIn the medically treated group, the mean baseline best corrected visual acuity (BCVA) (logMAR) was 1.38 ± 0.35. The BCVA was 1.21 ± 0.36 at the last visit for the medically treated group. In this group, one eye (12.5%) developed RD after 1 month of treatment. In the early PPV treatment group, the mean BCVA (logMAR) was 1.68 ± 0.26. The BCVA was 1.83 ± 0.21 at the last visit for the early PPV group. In this group, five eyes (29.4%) had recurrent RD before silicone oil removal. In the PPV group, the mean BCVA (logMAR) was 2.0 ± 0.35. The BCVA was 1.72 ± 0.34 at the last visit for the PPV group. In this group, one eye (11.1%) had recurrent RD before silicone oil removal. There were no significant differences among the three groups in the baseline BCVA and the BCVA at the last visit (p>0.05). There were no significant differences between the early PPV group and the PPV group in the recurrent RD rates (p = 0.38).ConclusionsProphylactic PPV showed no difference in recurrent RD rates or better BCVA. Therefore, prophylactic vitrectomy cannot prevent RD nor improve the prognosis of ARN based on our research.

Retinal Detachment After Acute Retinal Necrosis and the Efficacies of Different Interventions

“…Whether prophylactic PPV is beneficial in lowering the risk of RD secondary to ARN has remained controversial in current studies. 7,15,16 Our study indicated a positive role of prophylactic PPV, patients who…”

Sequential retinal necrosis secondary to varicella zoster in unrecognised long-standing HIV infection: patient safety report

“… 12 A recently published retrospective case series also reported disappointing visual outcomes in patients with ARN despite early pars plana vitrectomy surgery. 13 …”

Retinal Detachment Associated With Acute Retinal Necrosis

“…15,36 While there are multiple vision-threatening complications of ARN, RRD remains the primary cause of significant vision loss during the clinical course. 12,14,24,37,38 Patients with macula-involving retinitis or an associated optic neuropathy typically do poorly despite successful RRD repair. 7,39 Surgical success in the repair of ARN-associated RRDs can be complicated by the unique features of these detachments.…”