The Clinical Features Of Acute Retinal Necrosis, Treatment And Prognosis

Objective:To determine the viral diagnosis and the factors affecting the visual outcome of eyes with ARNDesign:Nonrandomized,retrospective,interventional,noncomparative series.31 patients (42 eyes) treated in our hospital from 1999 to 2009 were reviewed.Vitreous biopsies of 19 patients were sent to test antibody against HSV,CMV.Goldmann-Witmer coefficient was calculated.Nine of the vitreous biopsies were tested for antibody against VZV using ELISA.Intervention:Intravenous ganciclovir or acyclovir as well as intravitreal ganciclovir was administered for antivirus therapy. Systemic glucocorticosteroid was prescribed to alleviated the inflammation.Laser retinopexy was applied to prevent rhegmatogenous retinal detachment.Vitrectomy in combination with gas or silicone oil tamponade was performed in case RD occurs or vitreous opacity doesn't improved.Results:11 patient had bilateral ARN. All of them developed bilateral disease before antivirus treatment. The contralateral eye of all patient with unilateral ARN(20 patients) were not affected after systemic antivirus treatment.11 of 19 eyes(57.9%) were positive for virus antibody. Goldmann-Witmer coefficient was positive for HSV in 5 eyes(26.3%,5/19),and for CMV in 2 eyes(10.5%,2/19),including 1 eye in which Goldmann-Witmer coefficient was positive for both HSV and CMV. IgM antibody against HSV and CMV were positive in 2 eyes in vitreous body,respectively. IgM antibody against VZV was positive in 3 eyes (33.3%,3/9). Duration from onset of symptoms until first administration of antivirus drug in no RD subgroup(1-30d) is shorter than RD subgroup(7-60d) (P=0.001).Best corrected visual acuity better than 0.1 at the first visit was observed in 15 of 21 eyes in no RD subgroup and 8 of 21 eyes in RD subgroup(P=0.03).White-line-like blood vessels of optic disc(P=0.009),pallor papillae(P=0.045) and PVR(P=0.001) were more frequent in RD subgroup. RD occurred in 2 of 9 eyes received prophylactic laser retinopexy and 19 of 33 eyes that were not(P=0.13). Aslo,in 10 of 21 eyes reveived intravetreal ganciclover and 11 of 21 eyes that were not, RD developed without a significant difference(P=0.76). The retina of all eyes received vitreotomy with silicone oil tamponade(20 eyes) was reattached at final visit.6 of 20(30%) of these eyes gained a favourable visual acuity at final visit. In 57.1%(8/14) of no PVR eyes and 14.3%(4/28) of PVR eyes,visual acuity was improved at final visit(P=0.011). Among 22 eyes with better visual acuity at final visit,eyes with better visual acuity at the first visit(19/23) were more than those with worse visual acuity(3/19) (P=0.000). Better corrected visual acuity at final visit was also achieved in eyes without RD(P=0.000),white-line-like blood vessels(P=0.005) or PVR(P=0.000),respectively.Conclusions:The cause of ARN include VZV, HSV and CMV. Laser retinopexy and intravitreal ganciclovir fail to reduce RD,and their roles remain to be determined. Eye with RD had a worse prognosis. The crucial factor affecting the improvement of visual acuity is PVR. Earlier antivirus therapy leads to a better visual prognosis and can also spare contralateral eye. Vitreotomy with silicone oil tamponade could improve the prognosis.