Butler Nicholas J, Moradi Ahmadreza, Salek Sherveen S, Burkholder Bryn M, Leung Theresa G, Dunn James P, Thorne Jennifer E
Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Veterans Affairs Boston Healthcare System, Jamaica Plain, Massachusetts.
The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Am J Ophthalmol. 2017 Jul;179:179-189. doi: 10.1016/j.ajo.2017.05.006. Epub 2017 May 10.
To identify determinants of adverse outcomes in acute retinal necrosis (ARN), presenting characteristics and incidence rates of vision loss and ocular complications in a cohort of polymerase chain reaction (PCR)-positive eyes were analyzed.
Retrospective observational cohort study.
Forty-one eyes of 36 patients with clinically diagnosed ARN, PCR-positive for herpes simplex virus or varicella zoster virus and evaluated between January 2002 and June 2013, were included. Main outcome measures included incidence rates of vision loss and retinal detachment (RD).
Presenting visual acuity was generally poor (20/50 to >20/200 in 27%; 20/200 or worse in 56%). The incidence rate of ≤20/200 was 0.66/eye-year (EY), (95% confidence interval [CI], 0.32/EY to 1.22/EY); the rate of light perception or no light perception vision was 0.07/EY (95% CI, 0.02/EY to 0.16/EY). During follow-up, 59% of eyes developed at least 1 RD (rate = 0.40/EY, 95% CI, 0.19/EY to 0.58/EY). Eyes with retinitis involving ≥25% of the retina at presentation detached at nearly 12 times the rate, as compared to those with <25% retinal involvement (0.70/EY vs 0.06/EY; P = .001). Development of an RD was the greatest determinant of adverse visual outcomes, with 4% of eyes, that had experienced at least 1 RD, achieving a best-corrected visual acuity of ≥20/40 compared to 53% of eyes that never detached (P = .0003).
Poor outcomes in ARN were common in this cohort. RD confers the greatest risk of incident vision loss, and once 25% or more of the retina is involved the risk of RD and visual loss increases significantly.
为确定急性视网膜坏死（ARN）不良预后的决定因素，分析一组聚合酶链反应（PCR）阳性眼的视力丧失和眼部并发症的表现特征及发生率。
回顾性观察队列研究。
纳入2002年1月至2013年6月期间临床诊断为ARN、单纯疱疹病毒或水痘带状疱疹病毒PCR阳性且接受评估的36例患者的41只眼。主要观察指标包括视力丧失和视网膜脱离（RD）的发生率。
初诊时视力普遍较差（27%的患者视力为20/50至>20/200；56%的患者视力为20/200或更差）。视力≤20/200的发生率为0.66/眼年（EY）（95%置信区间[CI]，0.32/EY至1.22/EY）；光感或无光感视力的发生率为0.07/EY（95%CI，0.02/EY至0.16/EY）。随访期间，59%的眼发生了至少1次RD（发生率=0.40/EY，95%CI，0.19/EY至0.58/EY）。初诊时视网膜受累面积≥25%的视网膜脉络膜炎患者发生RD的几率是视网膜受累面积<25%患者的近12倍（0.70/EY对0.06/EY；P = 0.001）。发生RD是不良视力预后的最大决定因素，至少经历过1次RD的眼中有4%的眼最佳矫正视力≥20/40，而从未发生RD的眼中这一比例为53%（P = 0.0003）。
该队列中ARN的预后较差很常见。RD是视力丧失的最大风险因素，一旦视网膜受累面积达到25%或更多，RD和视力丧失的风险会显著增加。
