To evaluate the impact of selected clinical parameters on the mid-/long-term visual outcome of patients with acute retinal necrosis (ARN)
A retrospective cohort study
Two University Hospitals (Parma, Italy; Lausanne, Switzerland).
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).
BCVA at the final follow up
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).
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.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
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
Ganatra JB, Chandler D, Santos C et al (2000) Viral causes of the acute retinal necrosis syndrome. Am J Ophthalmol 129:166–172
Hillenkamp J, Nolle B, Bruns C et al (2009) Acute retinal necrosis: clinical features, early vitrectomy, and outcomes. Ophthalmology 116(10):1971–5.e2
Guex-Crosier T, Rochat C, Herbort CP (1997) Necrotizing herpetic retinopathies. Ocul Immunol Inflamm 5:259–265
Bonfioli AA, Eller AW (2005) Acute Retinal Necrosis. Semin Ophthalmol 20:155–160
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
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
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
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
Wong RV, Jumper JM, McDonald HR et al (2013) Emerging concepts in the management of acute retinal necrosis. Br J Ophthalmol 97:545–552
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
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
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)
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
Kaushik S, Lomi N, Singh MP, Pandav SS, Gupta A (2014) Acute retinal necrosis presenting as bilateral acute angle closure. Lancet 384(9943):636
Sheikh Z, Jain S, Hillen M et al (2016) Acute retinal necrosis in multiple sclerosis: a neuroimmunologic challenge. Neurology Mar 86(10):972–973
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
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
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
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]
Ishida T, Sugamoto Y, Sugita S, Mochizuki M (2009) Prophylactic vitrectomy for acute retinal necrosis. Jpn J Ophthalmol 53:486–899
The authors wish to thank Sally Louise Williams, MSc, and Susan Houghton for the English language editing and reviewing of the manuscript.
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.
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 was obtained from all available individual participants included in the study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
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
- Acute retinal necrosis (ARN)
- Visual outcome