Visual outcome and poor prognostic factors in acute retinal necrosis syndrome

A Correction to this article was published on 25 August 2020

This article has been updated

Abstract

Objective

To evaluate the impact of selected clinical parameters on the mid-/long-term visual outcome of patients with acute retinal necrosis (ARN)

Design

A retrospective cohort study

Methods

Setting

Two University Hospitals (Parma, Italy; Lausanne, Switzerland).

Participants

Thirty-nine non-HIV patients (39 eyes) with ARN, as confirmed by polymerase chain reaction on intraocular samples. The following potential predictors were tested using linear regression models: age, sex, etiology, best-corrected visual acuity (BCVA) on admission, delay between ARN symptom onset and treatment initiation, and surgery (performed or not).

Main outcome

BCVA at the final follow up

Results

Thirty-nine of 39 non-HIV patients (22 men and 17 women; mean age, 50 years) diagnosed with ARN were enrolled in the study. Etiologies were: varicella-zoster virus in 25 eyes (64%), herpes simplex viruses in the remaining 14 eyes. The average follow-up duration was 19 ± 13 months. All patients had undergone systemic antivirals; surgery was performed in 16 eyes. The mean delay between onset of visual symptoms and antiviral treatment initiation was 15 ± 31 days (range, 1–180 days). The mean BCVA at baseline was 0.83 ± 0.75 logMAR, while the mean final BCVA was 0.75 ± 0.81 logMAR. Both initial BCVA and treatment delay (TD) were significantly correlated with the final BCVA (p < 0.05).

Conclusions

Initial BCVA and TD seem to be significant predictors of mid-/long-term visual outcome in non-HIV patients affected by ARN.

This is a preview of subscription content, access via your institution.

Change history

  • 25 August 2020

    The original published online version contains mistake in the presentation of the first and last names of authors.

References

  1. 1.

    Holland GN (1994) Standard diagnostic criteria for the acute retinal necrosis syndrome. Executive Committee of the American Uveitis Society. Am J Ophthalmol 117:663–667

    CAS  Article  Google Scholar 

  2. 2.

    Ganatra JB, Chandler D, Santos C et al (2000) Viral causes of the acute retinal necrosis syndrome. Am J Ophthalmol 129:166–172

    CAS  Article  Google Scholar 

  3. 3.

    Hillenkamp J, Nolle B, Bruns C et al (2009) Acute retinal necrosis: clinical features, early vitrectomy, and outcomes. Ophthalmology 116(10):1971–5.e2

    Article  Google Scholar 

  4. 4.

    Guex-Crosier T, Rochat C, Herbort CP (1997) Necrotizing herpetic retinopathies. Ocul Immunol Inflamm 5:259–265

  5. 5.

    Bonfioli AA, Eller AW (2005) Acute Retinal Necrosis. Semin Ophthalmol 20:155–160

    Article  Google Scholar 

  6. 6.

    Wong RV, Pavesio CE, Laidlaw DA et al (2010) Acute retinal necrosis: the effects of intravitreal foscarnet and virus type on outcome. Ophthalmology 117:556–560

    Article  Google Scholar 

  7. 7.

    Yeh S, Suhler EB, Smith JR et al (2014) Combination systemic and intravitreal antiviral therapy in the management of acute retinal necrosis syndrome. Ophthalmic Surg Lasers Imaging Retina 45:399–407

    Article  Google Scholar 

  8. 8.

    Schoenberger SD, Kim SJ, Thorne JE et al (2017) Diagnosis and treatment of acute retinal necrosis: a report by the American Academy of Ophthalmology. Ophthalmology 124:382–392

    Article  Google Scholar 

  9. 9.

    Guex-Crosier Y, Meylan PR (2006) High dosage of oral valaciclovir as an alternative treatment of varicella zoster acute retinal necrosis syndrome. Eye 20:247

    CAS  Article  Google Scholar 

  10. 10.

    Wong RV, Jumper JM, McDonald HR et al (2013) Emerging concepts in the management of acute retinal necrosis. Br J Ophthalmol 97:545–552

    Article  Google Scholar 

  11. 11.

    Butler NJ, Moradi A, Salek SS et al (2017) Acute retinal necrosis: presenting characteristics and clinical outcomes in a cohort of polymerase chain reaction-positive patients. Am J Ophthalmol 179:179–189

    Article  Google Scholar 

  12. 12.

    Martinez-Serrano MG, Rodriguez-Reyes A, Guerrero-Naranjo JL et al (2016) Long-term follow-up of patients with choroidal neovascularization due to angioid streaks. Clin Ophthalmol 11:23–30

    Article  Google Scholar 

  13. 13.

    R Core Team (2017) R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL https://www.R-project.org/ (access 03/12/2019)

  14. 14.

    Werner RN, Nikkels AF, Marinović B, Schäfer M et al (2017) European consensus-based (S2k) guideline on the management of herpes soster - guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV), Part 2: treatment. J Eur Acad Dermatol Venereol 31:20–29

    CAS  Article  Google Scholar 

  15. 15.

    Kaushik S, Lomi N, Singh MP, Pandav SS, Gupta A (2014) Acute retinal necrosis presenting as bilateral acute angle closure. Lancet 384(9943):636

    Article  Google Scholar 

  16. 16.

    Sheikh Z, Jain S, Hillen M et al (2016) Acute retinal necrosis in multiple sclerosis: a neuroimmunologic challenge. Neurology Mar 86(10):972–973

    Article  Google Scholar 

  17. 17.

    Hafidi M, Janin-Manificat H et al (2019) Acute retinal necrosis virological features nusing quantitative PCR, therapeutic management, and clinical outcomes. Am J Ophthalmol 208:376–386

    CAS  Article  Google Scholar 

  18. 18.

    Risseeuw S, De Boer JH et al (2019) Risk of rhegmatogenous retinal detachment in acute retinal necrosis with and without prophylactic intervention. Am J Ophthalmol 206:140–148

    Article  Google Scholar 

  19. 19.

    Muthiah MN, Michaelides M, Child CS, Mitchell SM (2007) Acute retinal necrosis: a national population-based study to assess the incidence, methods of diagnosis, treatment strategies and outcomes in the UK. Br J Ophthalmol 91:1452–1455

    CAS  Article  Google Scholar 

  20. 20.

    Lei B, Zhou M, et al (2019) Ultra-wide-field fundus imaging of acute retinal necrosis: clinical characteristics and visual significance. Eye Sep 25. doi: https://doi.org/10.1038/s41433-019-0587-8. [Epub ahead of print]

  21. 21.

    Ishida T, Sugamoto Y, Sugita S, Mochizuki M (2009) Prophylactic vitrectomy for acute retinal necrosis. Jpn J Ophthalmol 53:486–899

    Article  Google Scholar 

Download references

Acknowledgments

The authors wish to thank Sally Louise Williams, MSc, and Susan Houghton for the English language editing and reviewing of the manuscript.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Guex-Crosier Yan.

Ethics declarations

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of each local Ethics Committee (i.e., Parma, Italy, ID: 1058/2018; and Lausanne, Switzerland, ID: 2019-00322) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all available individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Paolo, M., Marta, Z., Stefania, F. et al. Visual outcome and poor prognostic factors in acute retinal necrosis syndrome. Graefes Arch Clin Exp Ophthalmol 258, 1851–1856 (2020). https://doi.org/10.1007/s00417-020-04701-z

Download citation

Keywords

  • Acute retinal necrosis (ARN)
  • Visual outcome
  • Predictors
  • Treatment