Ophthalmologic Center of the Second Hospital, Jilin University, Changchun, PR China.
Eye (Lond). 2024 Dec;38(17):3382-3388. doi: 10.1038/s41433-024-03319-3. Epub 2024 Sep 11.
To analyse the prognostic factors for visual acuity in acute retinal necrosis (ARN) patients treated non-surgically.
The clinical data of ARN patients who visited our hospital from January 2010 to January 2023 were retrospectively analysed.
Twenty-four patients (29 eyes) were included. Aqueous humour samples were collected from 20 out of 29 eyes, and PCR confirmed that 85% (17/20) of the eyes had VZV infection, 10% (2/20) had CMV infection, and 5% (1/20) had HSV infection. All patients were treated with intravenous antiviral agents. Intravitreal ganciclovir and oral corticosteroids were given according to the patients' wishes. A comparison of visual acuity at the time of first identification of inactive ARN with that at the first visit revealed that 16 (55.2%) eyes improved and 13 (44.8%) did not improve. Logistic regression analysis revealed that risk factors for failure to improve vision after treatment included retinal detachment (odds ratio [OR],33.75; 95% CI, 3.245-351.067; P = 0.003), necrotising retinitis involving the posterior pole (odds ratio [OR],8.167; 95% CI, 1.297-51.403, P = 0.025), and arteritis involving the large retinal arteries (odds ratio [OR],9.167; 95% CI, 1.493-56.297; P = 0.017). The VZV viral load in the aqueous humour at initial presentation was significantly associated with visual prognosis (r = 0.688, P = 0.013), retinal detachment (τ = 0.597, P = 0.021) and the extent of retinal necrosis (τ = 0.57, P = 0.027). The neutrophil to lymphocyte ratio (NLR) of VZV-infected patients at first presentation was significantly correlated with the prognosis of visual acuity (r = 0.616, P = 0.033) and retinal detachment (τ = 0.728, P = 0.004).
High NLR and viral DNA copy number in the aqueous humour at the initial presentation, as well as subsequent retinal detachment, necrotising retinitis involving the posterior pole, and arteritis involving the large retinal arteries were risk factors for poor visual prognosis in VZV-infected ARN patients.
分析未经手术治疗的急性视网膜坏死（ARN）患者的视力预后因素。
回顾性分析 2010 年 1 月至 2023 年 1 月我院就诊的 ARN 患者的临床资料。
纳入 24 例（29 只眼）患者。对 29 只眼中的 20 只眼进行了房水样本采集，PCR 证实 85%（17/20）的眼有 VZV 感染，10%（2/20）有 CMV 感染，5%（1/20）有 HSV 感染。所有患者均接受静脉抗病毒药物治疗。根据患者意愿给予玻璃体内更昔洛韦和口服皮质类固醇。比较首次确定非活动 ARN 时的视力与首次就诊时的视力，发现 16 只（55.2%）眼视力改善，13 只（44.8%）眼视力未改善。Logistic 回归分析显示，治疗后视力未改善的危险因素包括视网膜脱离（优势比 [OR]，33.75；95%CI，3.245-351.067；P=0.003）、累及后极的坏死性视网膜炎（OR，8.167；95%CI，1.297-51.403，P=0.025）和累及大视网膜动脉的动脉炎（OR，9.167；95%CI，1.493-56.297；P=0.017）。初次就诊时房水中 VZV 病毒载量与视力预后显著相关（r=0.688，P=0.013），与视网膜脱离（τ=0.597，P=0.021）和视网膜坏死范围（τ=0.57，P=0.027）显著相关。初次就诊时 VZV 感染患者的中性粒细胞与淋巴细胞比值（NLR）与视力预后（r=0.616，P=0.033）和视网膜脱离（τ=0.728，P=0.004）显著相关。
初次就诊时高 NLR 和房水中病毒 DNA 拷贝数，以及随后的视网膜脱离、累及后极的坏死性视网膜炎和累及大视网膜动脉的动脉炎是 VZV 感染的 ARN 患者视力预后不良的危险因素。
