Clinical Observation Of Comprehensive Diagnosis And Treatment Of Acute Retinal Necrosis Syndrome

Objective:To evaluate the clinical effect of the comprehensive diagnosis and treatment of Acute retinal necrosis syndrome(ARNs),analyze the related factors affecting the prognosis of this disease,and provide some guidance for the diagnosis and treatment of ARNs.Methods:The clinical data of 17 cases(21 eyes)of ARNs treated in our hospital were analyzed retrospectively.There were 7 male patients and 10 female patients,aged38-65 years,with an average age of 51.94±8.30 years.PCR testing of aqueous humor was performed as soon as the patients was hospitalized,Antiviral treatment should not be delayed while awaiting PCR results.After adequate antiviral treatment,corticosteroid treatment was given.Prophylactic laser treatment was offered to patients with clear enough media to perform the procedure and enough viable retina to allow for it to be done without endangering the optic nerve or macula.Vitrectomy was offered to patients with retinal tear and even retinal detachment(RD).Medical data,includingsymptoms,visual acuity and intraocular pressure were recorded at presentation and subsequent follow-up periods.Analyze the prognostic factors of ARNs.Results:4 cases are binocular disease,13 cases are monocular disease,the contralateral eye did not develop during follow-up.After early antiviral and corticosteroid treatment,the best corrected visual acuity(BCVA)was improved in most of the patients,but dropped sharply after retinal detachment occurred in some cases.RD occurred in10 eyes,of which 7 eyes underwent vitrectomy with good retinal restoration,3 eyes gave up surgery.PCR testing were performed in 13 cases(16 eyes),the results were varicella-zoster virus(VZV)infection.Quantitated 1.44×10~5~1.90×10~7 copies/mL,with an average of 4.46×10~6±5.30×10~6 copies/mL.There was no significant correlation between the virus content and the symptoms and visual acuity.However,the more extensive the necrotic lesion is,and the more severe the vasculitis is,the higher incidence of RD and worse prognosis the patients have.Conclusion:1.PCR testing of aqueous humor is useful in supporting a clinical diagnosis of ARNs,especially in nontypical cases.2.After early antiviral and corticosteroid treatment,the BCVA was improved in most of the patients,but dropped after RD.3.There was no significant correlation between the virus content and the symptoms and visual acuity.4.High incidence of RD and worse prognosis happened in the patients who have more extensive necrotic lesion and more severe vasculitis.5.The role of prophylactic laser treatment in the prevention of RD deserves further investigation.