The Etiological And Therapeutic Study Of Acute Retinal Necrosis Syndrome

Acute retinal necrosis syndrome (ARN) is a fulminate viral retinitis with high risk of blindness. At present, several herpetic viruses have been demonstrated to be the causative agents for acute retinal necrosis. But the relationships among the virus kinds, numbers and pathologic mechanisms, clinical characteristics, prognoses remain uncertain. The purpose of this research is to analyze the viral cause and immunoregulatory cytokines in ocular fluid samples of ARN patients in Shanghai and investigate the clinical value of polymerase chain reaction (PCR) in detecting viral DNA .29 ARN cases were included in the study. Herpetic virus (n=40) and variable R1 region of varicella zoster virus (VZV) (n=7) DNA in intraocular fluid samples were amplified by PCR to detect the viral causes and differentiate VZV strains. Moreover, cytokines (IL-8,IL-10,IFN-() in ocular fluid samples (n=35)were measured by ELISA.To the best of our knowledge, this is the first study investigating the viral causes of ARN in China. VZV (n=16) and HSV-1 (n=3) were identified; VZV was the main causative virus (55%). Suitable time for PCR was the active phase without or with short time use of antiviral therapy. Aqueous humour might contribute to the reliable results with easy manipulation. The age of VZV ARN patients were similar to that of HSV-1, about 45 to 50 years old. HSV-1 ARN was always following viral encephalitis. In bilateral ARN, the prognosis of follow eyes was better than that of primary infected eyes. The number of VZV copies in ocular fluids tended to have positive correlation with retinal vasculitis and negative correlation with time of the retinal detachment. In typing VZV study, H-S1 and H-N3 similar strains were discovered. In addition, cytokines analysis showed that IL-8,IL-10,IFN-( were significantly higher within 2 to 3 weeks after onset. IFN-( can be used as a special signal indicating the acute stage of ARN, and the ratio of IFN-( to IL-10 might prognosticate the ARN prognosis.In prospective therapeutic study, the value and indication of prophylactic vitrectomy were investigated. 31 ARN cases were divided into 3 groups, non-operation group (n =11), prophylactic vitrectomy group (n =10) and post-RD operation group (n =10). The therapeutic effect of prophylactic vitrectomy with higher reattachment rate, simpler operation, fewer complications was better than that of the other group. Postoperative visual acuity of 70%cases in prophylactic vitrectomy group were better than 0.1. The indications of prophylactic vitrectomy was during 1 to 2 months of the disease course moderate to severe vitreous opacity can't be resolved and more than 1 quadrants of retina can't be seen after 2 weeks regular medicine treatment. The prophylactic vitrectomy study demonstrated that prompt surgery intervention might significantly improve the prognosis and contribute to better postoperative visual outcome.