Clinical Feature And Prognostic Factors In Acute Retinal Necrosis Syndrome

Objective:To explore the clinical feature of acute retinal necrosis syndrome(ARNs),evaluate the efficacies of current treatment options,and analyze prognostic factors associated with retinal detachment(RD)and vision loss.Methods:We performed a retrospective study of 61 patients(71 eyes)diagnosed with ARNs at the Second Hospital of Jilin University from September 2017 to October 2022.Data were collected regarding best corrected visual acuity(BCVA),aqueous humor analyses,initial manifestations of ARNs,treatment,and occurrence of retinal detachment,etc.Statistical analysis was performed to assess the clinical characteristics of the patients,the correlation of aqueous humor test results,and the impact of different ocular manifestations and treatment measures on prognosis.Results:1.The patients consisted of 32 males(36 eyes)and 29 females(35 eyes): 35 eyes in the right eye and 36 eyes in the left eye.The mean age was 52.46±10.02 years.The mean time of treatment delay was 18.87±17.80 days.The mean initial BCVA was1.50±0.84 log MAR,while the mean Post-treatment BCVA was 1.65±0.87 log MAR.2.Aqueous humor samples PCR was performed for 39 eyes,including VZV in 38 eyes(97.4%)and HSV in 1 eyes(3.6%).Viral load was significantly elevated with a mean of 1.61E+07±3.63E+07(range,5.29E+02-1.61E+07 copies/m L).3.The detection of cytokines in aqueous humor showed that significant increases in IL-6,IL-8,MCP-1 and VCAM,moderate increases in IL-10,VEGF and BFGF,and no increase in TNF-α.4.Viral load expression correlated with IL-8(r=0.668,P=0.000),IL-10(r=0.521,P=0.006),and VCAM(r=0.542,P=0.020).IL-6correlated with IL-8(r=0.729,P=0.000),IL-10(r=0.706,P=0.000),VEGF(r=0.689,P=0.000),and initial log MAR BCVA(r=0.385P=0.025).IL-8 correlated with IL-10(r=0.693,P=0.000)and VEGF(r=0.504,P=0.014)in addition to viral load and IL-6.IL-10 correlated with VEGF(r=0.528,P=0.010)and treatment delay time(r=-0.441,P=0.015)in addition to IL-6 and IL-8.VEGF correlated with IL-6,IL-8,and IL-10.5.Multivariate analysis showed that gender(P= 0.016),vitreous opacity(P= 0.000),optic disc edema(P= 0.004),optic disc unclear(P= 0.044),fundus hemorrhage type(P=0.019),retinal necrosis lesions involved zone(P= 0.006))were the independent risk factors for initial log MAR BCVA.6.Multivariate analysis showed that number of retinal necrosis lesions quadrants involved(P=0.007),intravitreal injection of ganciclovir + foscarnet(P=0.032;P=0.019)and prophylactic laser(P=0.049)were the independent influencing factors for RD.Prophylactic vitrectomy was significant in the univariate analysis of RD(P=0.002),but its effect could not be tested in multivariate analysis,and we need to increase the sample size in future studies.7.Multivariate analysis showed that initial log MAR BCVA(P=0.005),number of retinal necrosis lesions quadrants involved(P=0.006)and retinal detachment(P=0.002)were the independent risk factors for Post-treatment log MAR BCVA.Conclusions:1.Inflammatory factors play an important role in the disease process of patients with ARNs and are associated with viral load.Monitoring of both during the disease process can provide an important basis for comprehensive and accurate clinical management.2.Male,severe vitreous opacity,optic disc edema,fundus hemorrhage type,retinal necrosis near the posterior pole were associated with poorer initial log MAR visual acuity.3.Intravitreal injection of ganciclovir + foscarnet and prophylactic laser can significantly reduce the risk of RD.Prophylactic vitrectomy has a tendency to reduce the incidence of RD and warrants further study.4.Initial log MAR BCVA,number of retinal necrosis lesions quadrants involved,and RD are important predictors of Posttreatment log MAR BCVA,and number of retinal necrosis lesions quadrants involved was also an important predictor of RD.