Department, of Ophthalmology, Faculty of Medicine, University of Chile, Independencia 1027, Independencia, Santiago, Chile.
Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD, USA.
Graefes Arch Clin Exp Ophthalmol. 2021 Oct;259(10):2905-2911. doi: 10.1007/s00417-021-05166-4. Epub 2021 Apr 12.
Due to the guarded prognosis of acute retinal necrosis (ARN), it is relevant to develop a strategy to early categorize those patients in a higher risk of worse outcomes. The purpose of this study is to describe clinical features and predictive factors for retinal detachment (RD) in patients with ARN.
Retrospective observational case series of 34 adult patients (38 eyes) with ARN examined between January 2005 and July 2015 in the National Eye Institute (Bethesda, USA), the Department of Ophthalmology, University of Chile (Santiago, Chile), and APEC (CDMX, Mexico).
A total of 16 males and 18 females with a mean age at presentation of 44.5 ± 16.8 years were included. Twenty-seven patients (79.4%) received intravenous acyclovir as first-line treatment, and 7 patients received either oral antiviral (4 patients) or oral plus intravitreal antiviral (3 patients). All subjects were treated with prednisone, with a mean initial dose of 57.7 ± 16.3 mg per day. Seventeen patients (50.0%) developed retinal detachment. An association of retinal detachment with age at onset was observed (p = 0.04), with patients younger than 50 years presenting a higher risk (OR = 14.86, p = 0.0009). Additionally, patients in this higher risk group had more inflammation in both anterior chamber and vitreous (p = 0.04 and 0.03, respectively). No other predictive factor for retinal detachment was found in the present study.
RD represents an important complication in patients with ARN. Younger patients may be at higher risk of this complication, possibly secondary to the presence of a higher level of inflammation.
由于急性视网膜坏死（ARN）的预后较差，因此制定一种策略以早期对那些预后较差风险较高的患者进行分类是非常重要的。本研究的目的是描述 ARN 患者发生视网膜脱离（RD）的临床特征和预测因素。
这是一项回顾性观察性病例系列研究，纳入了 2005 年 1 月至 2015 年 7 月期间在美国国立眼科研究所（美国贝塞斯达）、智利大学眼科系（智利圣地亚哥）和 APEC（墨西哥城）接受检查的 34 例成年 ARN 患者（38 只眼）。
共纳入 16 名男性和 18 名女性患者，平均年龄为 44.5±16.8 岁。27 例（79.4%）患者接受了一线治疗阿昔洛韦静脉注射，7 例患者接受了口服抗病毒治疗（4 例）或口服加玻璃体内抗病毒治疗（3 例）。所有患者均接受了泼尼松治疗，平均初始剂量为 57.7±16.3mg/天。17 例（50.0%）患者发生了视网膜脱离。观察到视网膜脱离与发病年龄相关（p=0.04），50 岁以下的患者发生视网膜脱离的风险更高（OR=14.86，p=0.0009）。此外，该高风险组患者的前房和玻璃体内炎症程度更高（分别为 p=0.04 和 0.03）。本研究未发现视网膜脱离的其他预测因素。
RD 是 ARN 患者的一种重要并发症。年轻患者可能更容易发生这种并发症，可能是由于炎症水平较高所致。
