Mooss Vidya S, Murthy Krishna R, Babu Kalpana, Tirumalai Aniruddha A
Department of Uveitis and Ocular Inflammation, Prabha Eye Clinic and Research Center, Bengaluru, Karnataka, India.
Department of Vitreoretina, Prabha Eye Clinic and Vittala International Institute of Ophthalmology, Bengaluru, Karnataka, India.
Indian J Ophthalmol. 2025 Jun 1;73(6):858-863. doi: 10.4103/IJO.IJO_1585_24. Epub 2025 Apr 17.
To look at the clinical profile, treatment methods, and outcomes in cases of acute retinal necrosis (ARN) from a tertiary eye care center.
Hospital-based retrospective observational study wherein cases of ARN presented between January 2016 and December 2023 were reviewed. Demographic details, clinical presentation, complications, management, and visual outcome were evaluated.
Twenty eyes of 18 cases were included in the study. Mean age was 40.77 ± 16.38 years, male to female ratio was 2:1, and 11.11% had bilaterality at presentation. Mean duration of uveitis was 3.312 ± 0.95 months. The most commonly found organism was VZV (50%), followed by HSV (45%). All cases were given intravitreal ganciclovir in addition to systemic antivirals and oral steroids. The mean number of intravitreal injections was 5.53 ± 3.87. Maintenance dose of oral valacyclovir (500 mg twice daily) was continued in all cases for an average duration of 5.61 ± 3.79 months. The most common complications noted were retinal detachment (50%) followed by optic atrophy (44.44%). No significant association was noted between the extent of retinitis and the development of complications ( P = 0.215). However, there was a significant difference seen in the rate of complications between the HSV and VZV groups, with more complication rates seen with the VZV group ( P = 0.04). The mean visual acuity was 0.87 ± 0.85 logMAR at presentation and 0.65 ± 0.67 logMAR at the end of the study.
Timely diagnosis, aggressive initial treatment with intravitreal ganciclovir along with systemic antivirals and long-term maintenance therapy with systemic antivirals are crucial in ARN to obtain the best visual prognosis achievable and prevent lifelong disabilities.
观察一家三级眼科护理中心急性视网膜坏死（ARN）病例的临床特征、治疗方法及预后。
基于医院的回顾性观察研究，对2016年1月至2023年12月期间出现的ARN病例进行回顾。评估人口统计学细节、临床表现、并发症、治疗及视力预后。
该研究纳入了18例患者的20只眼。平均年龄为40.77±16.38岁，男女比例为2:1，11.11%的患者在就诊时为双侧受累。葡萄膜炎的平均病程为3.312±0.95个月。最常见的病原体是水痘-带状疱疹病毒（VZV，50%），其次是单纯疱疹病毒（HSV，45%）。所有病例均接受玻璃体内注射更昔洛韦，同时联合全身抗病毒药物和口服类固醇。玻璃体内注射的平均次数为5.53±3.87次。所有病例均持续口服伐昔洛韦维持剂量（500mg，每日两次），平均持续时间为5.61±3.79个月。最常见的并发症是视网膜脱离（50%），其次是视神经萎缩（44.44%）。视网膜炎症程度与并发症的发生之间未发现显著关联（P=0.215）。然而，HSV组和VZV组之间的并发症发生率存在显著差异，VZV组的并发症发生率更高（P=0.04）。就诊时的平均视力为0.87±0.85 logMAR，研究结束时为 0.65±0.67 logMAR。
在ARN中，及时诊断、积极的初始治疗（玻璃体内注射更昔洛韦联合全身抗病毒药物）以及长期的全身抗病毒维持治疗对于获得最佳视力预后和预防终身残疾至关重要。
