Kawaguchi Tatsushi, Spencer Doran B, Mochizuki Manabu
Department of Ophthalmology & Visual Science, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
Semin Ophthalmol. 2008 Jul-Aug;23(4):285-90. doi: 10.1080/08820530802111192.
Acute retinal necrosis is a progressive necrotizing retinopathy caused by herpes simplex virus (HSV) or varicella zoster virus (VZV). The mainstay of its treatment is antiviral therapy against these pathogenic organisms, such as intravenous acyclovir or oral valacyclovir. Systemic and topical corticosteroids together with antiviral therapy are used as an anti-inflammatory treatment to minimize damages to the optic nerve and retinal blood vessels. Because the majority of severe cases of the disease show occlusive retinal vasculitis, a low dosage of aspirin is used as anti-thrombotic treatment. Vitreo-retinal surgery is useful to repair rhegmatogenous retinal detachment, one of the main late-stage complications. Moreover, recent articles have reported some encouraging results of prophylactic vitrectomy before rhegmatogenous retinal detachment occurs. The efficacy of laser photocoagulation to prevent the development or extension of rhegmatogenous retinal detachment is controversial. Despite these treatments, the visual prognosis of acute retinal necrosis is still poor, in particular VZV-induced acute retinal necrosis.
急性视网膜坏死是一种由单纯疱疹病毒（HSV）或水痘-带状疱疹病毒（VZV）引起的进行性坏死性视网膜病变。其主要治疗方法是针对这些致病微生物进行抗病毒治疗，如静脉注射阿昔洛韦或口服伐昔洛韦。全身和局部使用糖皮质激素联合抗病毒治疗作为抗炎治疗，以尽量减少对视神经和视网膜血管的损害。由于该疾病的大多数严重病例表现为闭塞性视网膜血管炎，因此使用低剂量阿司匹林作为抗血栓治疗。玻璃体视网膜手术对于修复孔源性视网膜脱离（主要的晚期并发症之一）很有用。此外，最近的文章报道了在孔源性视网膜脱离发生前进行预防性玻璃体切除术的一些令人鼓舞的结果。激光光凝预防孔源性视网膜脱离发展或扩展的疗效存在争议。尽管有这些治疗方法，但急性视网膜坏死的视觉预后仍然很差，尤其是由VZV引起的急性视网膜坏死。
