Agarwal Manisha, Gupta Chanda, Jain Abhishek, Kumar Brajesh
Vitreo-retina Department, Dr Shroff's Charity Eye Hospital, 5072, Kedarnath Road, Daryaganj, New Delhi, 110002, India.
J Ophthalmic Inflamm Infect. 2020 Feb 12;10(1):8. doi: 10.1186/s12348-020-0199-2.
Acute retinal necrosis (ARN) is a potentially blinding necrotizing viral retinitis. It starts with one or more foci and spreads circumferentially and involves the posterior pole in the later stages. Vascular occlusions such as branch retinal artery occlusion, central retinal artery occlusion, and central retinal vein occlusion may occur secondary to underlying infectious etiology such as ARN.
An elderly male patient with a history of coronary artery disease was diagnosed with branch retinal artery occlusion (BRAO) in the right eye and referred to the treating cardiologist. Few days later, he complained of diminution of vision in the left eye which made him seek another consultation when he was diagnosed to have ARN in the left eye, encroaching the posterior pole. He was investigated and treated for the same leading to minimal improvement of vision in the left eye possibly due to a delay in the starting of the anti-viral therapy.
We report this case to highlight that occlusive vasculopathy can be a presenting sign of an underlying infectious etiology in any age group. BRAO was a rare presenting sign of ARN in our patient. A thorough peripheral examination is recommended in order to avoid missing infectious pathologies such as ARN which starts from the retinal periphery, progresses fast, and if not managed on time may lead to permanent loss of vision.
急性视网膜坏死（ARN）是一种潜在致盲的坏死性病毒性视网膜炎。它始于一个或多个病灶，呈环形扩散，后期累及后极部。诸如视网膜分支动脉阻塞、视网膜中央动脉阻塞和视网膜中央静脉阻塞等血管闭塞可能继发于潜在的感染病因，如ARN。
一名有冠状动脉疾病史的老年男性患者右眼被诊断为视网膜分支动脉阻塞（BRAO），并被转诊至主治心脏病专家处。几天后，他主诉左眼视力下降，在被诊断为左眼ARN且病变累及后极部时前来寻求进一步会诊。他接受了相关检查和治疗，但左眼视力改善甚微，可能是因为抗病毒治疗开始延迟。
我们报告该病例以强调闭塞性血管病变可能是任何年龄组潜在感染病因的表现症状。BRAO是我们患者中ARN罕见的表现症状。建议进行全面的周边检查，以避免漏诊诸如ARN等感染性疾病，ARN始于视网膜周边部，进展迅速，若不及时治疗可能导致永久性视力丧失。
