Surgical management of Acute Retinal Necrosis (ARN): timing and outcomes

Abstract

PurposeTo evaluate the demographics, etiology, clinical and surgical management, and functional outcomes of an Acute Retinal Necrosis (ARN) series from a referral Italian Centre. Both clinical characteristics and treatment strategies of ARN are valid and debated issues. Several dedicated articles appear every year in highly impacted medical journals.MethodsObservational series of biopsy‐proven ARN cases between January 2010 and March 2017. All the considered patients had the last visit in 2017. Soon after diagnosis patients had received systemic antiviral therapy according to the specific guidelines. No intravitreal injections or “early” (i.e. in the absence of retinal detachment, RD) pars plana vitrectomy (PPV) were adopted.ResultsSeven patients (5 men) were included with a mean age of 52 ± 18 years (range 31–78 years). HZV was detected in 4 cases, HSV in 2 cases, CMV in 1 case (the sole with positive serology for HIV). PPV was performed in 6/7 subjects, with a mean delay of 43±33 days since diagnosis. Only in 1 case silicone tamponade removal was successfully reached. A second PPV was required in 4/6 patients, because of RD recurrence or posterior bleeding. In one HSV case a complete healing was achieved with medical treatment. Visual acuity (VA) averagely improved in the whole cohort either between diagnosis (0.91 ± 0.25 logMAR) and the end of follow up (0.77±0.51 logMAR); or between preoperatively (1.15 ± 0.03 logMAR) and the end of follow up. In both cases, however, statistic was not significant (p > 0.05).ConclusionsThe efficacy of prophylactic laser in our series, as in the literature, remains unclear. VA improvement was achieved even without early PPV. This evidence, along with the possible adjuvant effect of intravitreal antivirals, warrant comparative discussion with literature data.