Analysis Of Clinical Comprehensive Treatment Of Acute Retinal Necrosis Syndrome

Objective:To evaluate the effect of comprehensive treatment of acute retinal necrosis syndrome.Methods:We collected the clinical data of patients who were diagnosed as acute retinal necrosis syndrome according to systematic eye examination and international diagnostic criterions and admitted to the Department of Ophthalmology,Second Hospital of Jilin university between September 2017 and November 2019.All the patients were given antiviral drugs systemically(intravenous injection followed by oral treatment)and locally(intravitreal injection).Patients without glucocorticoid contraindication were asked to take prednisolone orally,otherwise were given methylprednisolone periorbital injection.In addition to medication therapy,some patients received intervention treatment(retinal laser photocoagulation or vitrectomy combined silicone oil tamponade and retinal laser photocoagulation)according to indications.All the patients were followed up for at least 6 months.The visual acuity,intraocular pressure,changes of manifestation,virus titre and the occurrence or retinal detachment were recorded.In order to analyze the influence of intravitreal antivirus,we divided patients into groups based on the dose or kind of antiviral drugs injected into vitreous.To explore the efficacy of intervention treatment in maintaining anatomical integrated and visual function,we separated patients into intervention group and non-intervention group.Results:Thirty-five patients(43 eyes)were included in this study,while 8(22.86%)patients had bilateral acute retinal necrosis syndrome and the interval of infection between their two eyes was 13.5±10.09 days.There were14 males(17 eyes)and 21 females(26 eyes)among all the subjects with an average age of 52.49±8.87 years.The average duration of ocular symptoms before admission was 10.85±7.45 days.Etilogical diagnosis was made in 24 patients' early-onset eyes after initial clinical evaluation.Varicella-zoster virus was the most frequent pathogen(21 eyes,87.5%)and the nucleic acid titre was lg6.7 copy/mL(lg5.73-lg7.07 copy/mL).There were two cases of herpes simplex virus(8.33%)and one case of varicella-zoster virus combined with EpsteinBarr virus(4.17%)infected.All the patients were treated with systemic(intravenous antiviral therapy followed by oral antiviral treatment),local(intravitreal injections,3.57±1.55 times)antiviral therapy and corticosteroid therapy(oral or periorbital).The fundus lesions showed a tendency of regression at 6.24 ± 3.61 days after antiviral therapy began.The best corrected visual acuity at onset was 1.9(0.85-2.3)logMAR.After intravenous antiviral therapy,the best corrected visual acuity improved to 1.3(0.7-2.3)logMAR.According to different dose and kind of antiviral drugs injected into vitreous,35 patients were separated into different groups: ganciclovir group(24 patients)and ganciclovir + foscarnet group(11 patients);low dose ganciclovir group(18 patients)and high dose ganciclovir group(6 patients).There was a lower rate of retinal detachment(p=0.01)and a larger decrease of virus titre(p=0.042)in patients who were treated by ganciclovir+foscarnet compared with those who received ganciclovir only.The differences in visual outcome,proportion of retinal detachment between high dose and low dose ganciclovir groups were not significant.Beside medication therapy,8 patients underwent intervention therapy(2 retinal laser photocoagulation,6 vitrectomy combined silicone oil tamponade and retinal laser photocoagulation)according to indications.At 6-month follow-up,the best corrected visual acuity was 2.6(2.07-2.9)logMAR in non-intervention group(27 patients)with 21 patients(77.78%)occurred retinal detachment.While the best corrected visual acuity of intervention group was 1.2(0.73-2.23)logMAR and all the patients' retinas remain attached.The lower presence of retinal detachment was associated with timely intervention in our study(p<0.001).Conclusion:Systemic and local antiviral therapy combined with corticosteroid therapy can prevent the deterioration of acute retinal necrosis syndrome and maintain visual acuity to a certain extent.Regarding the choice of intravitreal injection of antiviral drugs,the combination of ganciclovir and foscarnet can reach a lower incidence of retinal detachment and a greater decrease in intraocular virus than using ganciclovir alone,whereas there is no significant difference between high dose and low dose ganciclovir group in visual prognosis.Retinal laser photocoagulation or vitrectomy combined silicone oil tamponade and retinal laser photocoagulation may provide stable anatomical outcome for patients.