Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA.
Retina. 2010 May;30(5):795-800. doi: 10.1097/IAE.0b013e3181c7013c.
The purpose of this study was to report long-term visual outcome of acute retinal necrosis.
Medical records of patients with acute retinal necrosis were reviewed.
Thirty-two patients were diagnosed with acute retinal necrosis from 1998 to 2007. Twenty patients (25 eyes) had at least 1 follow-up and available medical records. Intravitreal injections of ganciclovir and/or foscarnet were administered in 11 of 25 eyes. Intravenous and oral antiviral medications were used in 14 of 20 and 19 of 20 patients, respectively. Eleven of 25 eyes had <25% of retina affected, 8 of 25 had 25% to 50% of retina affected, and 6 of 25 had >50% of retina affected. Mean visual acuity at all time points was best when retinitis involved <25% and decreased as area increased. All but 1 eye with >50% involvement experienced decreased vision regardless of treatment. Three of 4 eyes with 25% to 50% involvement that received intravitreal antivirals had an improvement in visual acuity of > or =2 Snellen lines. Five of 25 eyes developed retinal detachment. None of the six eyes treated with prophylactic laser detached.
Greater extent of retinitis portends a worse visual prognosis. Although intravitreal treatment did not prevent visual acuity loss in patients with severe disease, patients with moderate disease (25-50% retina involved) did well with intravitreal therapy with most having stable or improved visual acuity. Prophylactic laser decreased the rate of detachment.
本研究旨在报告急性视网膜坏死的长期视觉预后。
回顾了诊断为急性视网膜坏死的患者的病历。
1998 年至 2007 年，共诊断出 32 例急性视网膜坏死患者。20 例（25 只眼）至少有一次随访和可用的病历记录。25 只眼中有 11 只眼接受了更昔洛韦和/或膦甲酸玻璃体腔内注射。20 例患者中有 14 例使用了静脉和口服抗病毒药物，20 例患者中有 19 例使用了静脉和口服抗病毒药物。25 只眼中，11 只眼受累视网膜<25%，8 只眼受累视网膜 25%至 50%，6 只眼受累视网膜>50%。当视网膜炎累及<25%时，各时间点的平均视力最佳，随着面积的增加而下降。除 1 只眼外，受累>50%的所有眼视力均下降，无论治疗与否。接受玻璃体腔内抗病毒药物治疗的 25%至 50%受累的 4 只眼中，有 3 只眼视力提高≥2 行 Snellen 线。25 只眼中有 5 只发生视网膜脱离。未接受预防性激光治疗的 6 只眼中无一例发生视网膜脱离。
视网膜炎受累范围越广，预示着预后越差。尽管玻璃体腔内治疗不能预防严重疾病患者视力丧失，但中度疾病（25%-50%视网膜受累）患者接受玻璃体腔内治疗效果良好，大多数患者视力稳定或改善。预防性激光降低了脱离的发生率。
