Müller B, Velhagen K H, Pleyer U
Augenklinik, Charité Campus Virchow-Klinikum, Humboldt-Universität zu Berlin, Augustenburger Platz 1, Berlin.
Klin Monbl Augenheilkd. 2000 Dec;217(6):345-50. doi: 10.1055/s-2000-9573.
Acute retinal necrosis syndrome (ARN) might be complicated by retinal detachment, vasculopathy and optic neuropathy and has a poor prognosis despite intensive medical and surgical therapy.
A series of 10 consecutive patients (14 eyes) with ARN were followed for 36 months (average of 20 months +/- 10). We present the results of the clinical evaluation for diagnostic and therapeutic modalities.
Viral etiology was confirmed in 9 of 10 aqueous-humor samples. Intraocular antibody synthesis against Varicella-Zoster Virus was found in 7, against Herpes-Simplex Virus in 5 and against Cytomegalovirus in 2 samples. Three eyes had a mild clinical course with a visual acuity of 0.6 or better. Vitrectomy and silicone-oil tamponade preserved visual acuity from 0.3 to 0.1. ARN lead to blindness in 5 eyes due to vasculopathy, optic neuropathy or retinal detachment. An arterial branch occlusion was successfully overcome with i.v. heparin treatment in one patient.
Aqueous-humor analysis supports clinical diagnosis. Early vitrectomy and silicone oil tamponade stabilizes retinal structure and preserves visual acuity. Occlusive vasculopathy and optic neuropathy are the main causes leading to blindness.
急性视网膜坏死综合征（ARN）可能并发视网膜脱离、血管病变和视神经病变，尽管进行了强化药物和手术治疗，但其预后仍较差。
连续随访了10例（14只眼）ARN患者36个月（平均20个月±10个月）。我们展示了诊断和治疗方式的临床评估结果。
10份房水样本中有9份证实了病毒病因。在7份样本中发现了针对水痘 - 带状疱疹病毒的眼内抗体合成，5份针对单纯疱疹病毒，2份针对巨细胞病毒。3只眼临床过程较轻，视力为0.6或更好。玻璃体切除术联合硅油填充使视力维持在0.3至0.1。由于血管病变、视神经病变或视网膜脱离，ARN导致5只眼失明。1例患者经静脉注射肝素治疗成功克服了动脉分支阻塞。
房水分析有助于临床诊断。早期玻璃体切除术和硅油填充可稳定视网膜结构并保留视力。闭塞性血管病变和视神经病变是导致失明的主要原因。
