Department of Ophthalmology, Mie University Graduate School of Medicine, Mie, Japan.
Medicine (Baltimore). 2024 May 17;103(20):e38150. doi: 10.1097/MD.0000000000038150.
Acute retinal necrosis (ARN) was first reported in 1971 by Urayama et al as an acute uveitis accompanied by retinal arteritis and white retinal lesions in the peripheral retina that can progress to a rhegmatogenous retinal detachment (RRD). We have experienced a case of ARN that, unlike the common developmental course to an RRD associated with ARN, progressed to proliferative vitreoretinopathy (PVR) involving the entire retina in 2 days. The purpose of this report is to present our findings in the case of ARN with an atypical rapid time course.
The patient was a 56-year-old woman who was treated for uveitis of unknown origin by her primary care physician. She was referred to our hospital because of a worsening of the fundus findings.
Fundus examination in our hospital revealed vitreous opacities in the right eye, yellowish-white lesions extending around the retina, and some retinal hemorrhages. Because the retinal changes suggested ARN, we performed a polymerase chain reaction of the anterior atrial fluid and detected varicella-zoster virus. Then, the diagnosis of ARN was confirmed, and treatment was begun. At 1 month and a half after beginning the treatment, focal retinal traction was observed in the right fundus. Two days later, a circumferential PVR and a total retinal detachment were detected.
We then performed vitrectomy with an encircling buckle and a silicone oil tamponade.
Our examination 6 months postoperatively showed that the retina was attached and the BCVA was 20/200.
Our findings of a case of ARN showed that the progression from a local vitreous traction to a full circumferential PVR can develop in 2 days.
急性视网膜坏死（ARN）于 1971 年由 Urayama 等人首次报道，是一种伴有视网膜动脉炎和周边视网膜白色视网膜病变的急性葡萄膜炎，可进展为孔源性视网膜脱离（RRD）。我们遇到了一例 ARN 病例，与常见的 ARN 相关的 RRD 发展过程不同，该病例在 2 天内进展为累及整个视网膜的增殖性玻璃体视网膜病变（PVR）。本报告的目的是介绍我们在 ARN 病例中发现的一种非典型的快速病程。
患者为 56 岁女性，因不明原因的葡萄膜炎在初级保健医生处接受治疗。因眼底发现恶化而转至我院。
我院眼底检查发现右眼玻璃体混浊，视网膜周围有黄白色病变，并有一些视网膜出血。由于视网膜变化提示 ARN，我们对前房液进行了聚合酶链反应检测，发现了水痘带状疱疹病毒。随后，确诊为 ARN，并开始治疗。治疗开始后 1 个半月，右眼眼底出现局灶性视网膜牵引。两天后，发现全环 PVR 和完全性视网膜脱离。
我们随后进行了玻璃体切除术，并使用环扎带和硅油填充。
术后 6 个月的检查显示视网膜贴附，BCVA 为 20/200。
我们对 ARN 病例的发现表明，局部玻璃体牵引到全环 PVR 的进展可以在 2 天内发生。
