Acute Retinal Necrosis Syndrome Research Articles

Acute Retinal Necrosis Complicated by Serous Retinal Detachment Associated with Varicella-Zoster Virus Infection in an Immunocompetent Young Adult

Acute retinal necrosis syndrome (ARN syndrome) is a rare, rapidly progressive viral retinitis with a grim functional prognosis. We present a case of a 43-year-old immunocompetent woman who experienced unilateral acute retinal necrosis, with Varicella-Zoster Virus (VZV) infection as the etiology. A unilateral vesicular facial rash accompanied by rapidly declining visual acuity over 7 days prompted consultation. Intravenous antiviral treatment and panretinal photocoagulation laser (PPR) were initiated, followed by antiviral prophylaxis. The patient developed ophthalmic zona lesions, peripheral retinal ischemia, and unilateral macular serous retinal detachment (SRD). Treatment included valacyclovir, corticotherapy and PPR laser. Knowledge of this condition, diagnosed clinically, is crucial due to its rapid progression and severe complications. Early intervention appears to be a significant prognostic factor, emphasizing its therapeutic urgency.

Clinical pattern and outcomes of acute retinal necrosis in a referral Center in Tunisia, North Africa: A 17‐year retrospective study

Aims/Purpose: To describe the pattern of acute retinal necrosis (ARN) in a referral centre in Tunisia, North Africa.Methods: The charts of 22 patients diagnosed with ARN from January 2006 to January 2023 were retrospectively reviewed.Results: The mean age at presentation was 39.2 (range, 12–70) years, sex ratio was 1.75. The mean diagnostic delay was 17.9 days (range 1–60). The mean visual acuity at presentation was 20/400. All patients presented with a mild to moderate anterior uveitis (100%) with granulomatous keratic precipitates in 18 eyes (81%) and ocular hypertension in 4 eyes (18%). Necrotizing retinitis involved >50% of the retina in 36.5%of eyes. Polymerase chain reaction on aqueous humour sample identified varicella zoster virus in 10 eyes (45%), herpes simplex virus‐1 in 4 eyes (18%) and was negative in 8 eyes (22%). All patients received intravenous acyclovir, followed by oral antivirals. Intravitreal injections of ganciclovir were administered in 12 eyes (54.5%). Follow‐up ranged from 1 month to 48 months. The mean final visual acuity was 20/200. Complications included retinal detachment (RD) (31.8%), macular oedema (18%), macular atrophy (22%), epimacular membrane (22%), cataract (27%), optic nerve atrophy (18%) and central retinal artery occlusion (4%). No patient developed bilateral ARN. Prophylactic laser was performed in 7 eyes (32%). RD was treated with pars plana vitrectomy and silicone oil injection in 7 eyes.Conclusions: ARN syndrome in Tunisia is most commonly caused by VZV.

A case report of isolated primary herpes-simplex virus neuroretinitis in an immunocompetent adult

BackgroundHerpes simplex virus (specifically HSV-1 and HSV-2) are greatly prevalent viruses that can cause conjunctivitis, keratitis and other rarer ocular disorders such as acute retinal necrosis syndrome or neuroretinitis. We report a case of an isolated unilateral neuroretinitis with primary HSV infection in an immunocompetent adult without other related clinical features.Case presentationA 60-year-old immunocompetent woman presented with sudden painless central vision loss in her left eye (best corrected visual acuity was 20/200) showing optic disc edema, submacular fluid and a delayed development of a macular star. The macular optical coherence tomography (OCT) showed a serous retinal detachment. Arterial hypertension or exposure to ionizing radiation were ruled out and the microbiological blood test battery was only positive for immunoglobulin M (IgM) for HSV-1 which allowed etiological treatment with oral valacyclovir. Complete resolution and good visual results were found within 3 months.ConclusionsThe present case of isolated neuroretinitis as a primary HSV infection in an immunocompetent patient was resolved with good functional results after valacyclovir treatment. Presence of HSV IgM in absence of other laboratory results could be enough evidence to start HSV treatment in immunocompetent patients with a macular star, as an isolated lesion, after ruling out other non-infectious causes, such as arterial hypertension or exposure to ionizing radiation. Rare infectious agents in immunocompetent patients must be considered in the differential diagnosis of neuroretinitis, even if there are no other typical symptoms or signs that could suggest the disease.

Acute Retinal Necrosis a Potentially Visual Devastating Affection

Acute retinal necrosis syndrome (ARN syndrome) is a rare condition, caused by DNA viruses. The diagnosis of this condition is mainly based on the suggestive clinical appearance. Prompt diagnosis and treatment is crucial to prevent visual loss. We report the case of 56-year-old women, diabetic, who presented to the emergency room for rapid decrease of visual function of her left eye, which revealed granulomatous uveitis with retinal necrosis.

Classification Criteria for Acute Retinal Necrosis Syndrome

To determine classification criteria for acute retinal necrosis (ARN). Machine learning of cases with ARN and 4 other infectious posterior uveitides / panuveitides. Cases of infectious posterior uveitides / panuveitides were collected in an informatics-designed preliminary database, and a final database was constructed of cases achieving supermajority agreement on diagnosis, using formal consensus techniques. Cases were split into a training set and a validation set. Machine learning using multinomial logistic regression was used on the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the infectious posterior uveitides / panuveitides. The resulting criteria were evaluated on the validation set. Eight hundred three cases of infectious posterior uveitides / panuveitides, including 186 cases of ARN, were evaluated by machine learning. Key criteria for ARN included (1) peripheral necrotizing retinitis and either (2) polymerase chain reaction assay of an intraocular fluid specimen positive for either herpes simplex virus or varicella zoster virus or (3) a characteristic clinical appearance with circumferential or confluent retinitis, retinal vascular sheathing and/or occlusion, and more than minimal vitritis. Overall accuracy for infectious posterior uveitides / panuveitides was 92.1% in the training set and 93.3% (95% confidence interval 88.2, 96.3) in the validation set. The misclassification rates for ARN were 15% in the training set and 11.5% in the validation set. The criteria for ARN had a reasonably low misclassification rate and seemed to perform sufficiently well for use in clinical and translational research.

Nursing Care of 13 Cases with Acute Retinal Necrosis Associated with HIV/AIDS during Day Surgery

Objective: Summarizing the nursing points from the treatment of the 13 cases of AIDS-related acute retinal necrosis syndrome (ARNS). Methods: Retrospective analysis of clinical nursing process of 13 cases (15 eyes) of AIDS-related ARNS patient treated in our hospital from January to December 2019. Results: The retina of all the patients were flat after operation. Postoperative visual acuity: bilateral visual acuity 0.1 in 11 eyes, 0.01 - 0.1 in 3 eyes, >0.1 in 1 eye. No adverse events and nursing safety events occurred. Patients recovered well after operation during the follow-up after discharge. Conclusion: The focus of nursing care for patients with HIV/AIDS combined with acute retinal necrosis during daytime surgery is multifaceted, apart from the daily, perioperative nursing in day-care unit, continuous nursing, psychological counseling, disinfection and isolation should be paid attention to. At the same time, with the help of promotion and application of information education means, the treatment compliance of patients can be improved, which plays an essential role in the advance of the treatment effect.

Acute retinal necrosis: Clinical manifestation and long-term visual outcomes in a series of polymerase chain reaction-positive patients.

To report the clinical spectrum, viral etiologies, therapeutic interventions, timing of rhegmatogenous retinal detachments (RRD), and visual outcomes in acute retinal necrosis (ARN) syndrome in a series of polymerase chain reaction (PCR)-positive eyes. From January 2010 to January 2017, consecutive patients with the clinical diagnosis of ARN and a positive aqueous viral PCR were included in this observational, retrospective study. Nineteen eyes found to have a clinical diagnosis of ARN, of which 18 (94.7%) had a positive viral PCR. ARN was unilateral, except in one patient. None of the fellow eyes manifested ARN during follow-up. Varicella-zoster virus (VZV) was detected in 78.0% of ARN eyes. 61.1% of eyes experienced RRD. The median time for the occurrence of RRD was 12 weeks (range: 6-25 weeks) after disease onset. No correlation was found between the etiologic viral agent (VZV vs non-VZV; p = 1.000), extent of retinitis (1-2 quadrant vs 3-4 quadrants; p = 0.326), administration of intravitreal ganciclovir (injected vs not injected; p = 0.332), application of prophylactic laser retinopexy (applied vs not applied; p = 0.326), and subsequent occurrence of RRD.At a 2-year follow-up, visual impairment (VA ⩽ 20/200) and severe visual loss (VA ⩽ light perception) were significantly higher in those complicated by RRD compared to non-RRD eyes (81.8% vs 28.6%; p = 0.047, and 45.4% vs 0.0%; p = 0.004, respectively). Aqueous PCR results are highly consistent with the clinical diagnosis of ARN. Regardless of the method of management, the rate of RRD is high and is associated with a poor visual outcome.

Visual outcome and poor prognostic factors in acute retinal necrosis syndrome.

To evaluate the impact of selected clinical parameters on the mid-/long-term visual outcome of patients with acute retinal necrosis (ARN) A retrospective cohort study Two University Hospitals (Parma, Italy; Lausanne, Switzerland). Thirty-nine non-HIV patients (39 eyes) with ARN, as confirmed by polymerase chain reaction on intraocular samples. The following potential predictors were tested using linear regression models: age, sex, etiology, best-corrected visual acuity (BCVA) on admission, delay between ARN symptom onset and treatment initiation, and surgery (performed or not). BCVA at the final follow up Thirty-nine of 39 non-HIV patients (22 men and 17 women; mean age, 50years) diagnosed with ARN were enrolled in the study. Etiologies were: varicella-zoster virus in 25 eyes (64%), herpes simplex viruses in the remaining 14 eyes. The average follow-up duration was 19 ± 13months. All patients had undergone systemic antivirals; surgery was performed in 16 eyes. The mean delay between onset of visual symptoms and antiviral treatment initiation was 15 ± 31days (range, 1-180days). The mean BCVA at baseline was 0.83 ± 0.75logMAR, while the mean final BCVA was 0.75 ± 0.81logMAR. Both initial BCVA and treatment delay (TD) were significantly correlated with the final BCVA (p< 0.05). Initial BCVA and TD seem to be significant predictors of mid-/long-term visual outcome in non-HIV patients affected by ARN.

Acute Retinal Necrosis: Virological Features Using Quantitative Polymerase Chain Reaction, Therapeutic Management, and Clinical Outcomes

To evaluate outcomes of patients treated with intensive intravitreal therapy and to describe the evolution of quantitative real-time polymerase chain reaction (qPCR) in patients treated for acute retinal necrosis (ARN) syndrome. Retrospective observational case series. This study included 25 eyes of 24 patients with ARN who were treated and followed up in 2 departments of ophthalmology in Lyon, France. Assessed outcomes included qPCR viral load profile during treatment, number of antiviral intravitreal injections (IVT), retinal detachment rate, and best-corrected visual acuity. Final visual acuity was 20/200 or less in 20% of cases; the rate of retinal detachment was 16%. Viral load kinetics changed in 3 phases: a first plateau period that was not consistent, a logarithmic decrease phase, and a negativation phase. Mean decay of the logarithm of the viral load was estimated at 0.076 per day; mean time of negativation was 56.1days. Median IVT number was 9 (range, 0-28). Ten patients were treated with injections until the viral load was undetectable. Resistance to acyclovir was observed in a patient with a prolonged initial plateau of the viral load. Numerous and prolonged IVTs, used as adjunctive therapy, could improve the prognosis of treated patients by decreasing the risk of retinal detachment and improving visual acuity. QPCR enables monitoring of the response to treatment and can provide evidence for resistance to antiviral treatment by enabling the detection of cases with a prolonged initial plateau of viral load.

A rare case of bilateral acute retinal necrosis due to varicella zoster virus in a patient of Multiple myeloma

Acute retinal necrosis syndrome (ARN) is a well-defi ned entity with characteristic clinical picture of progressive intraretinal infl ammation and necrosis and is caused by one of the members of the Herpes group of viruses. The condition occurs typically in otherwise healthy patients.

Advancement in diagnosis and treatment of acute retinal necrosis syndrome

Advancement in diagnosis and treatment of acute retinal necrosis syndrome

Herpetic Encephalitis Lead to Acute Retinal Necrosis

Objective: The purpose of this study is to enhance the known onset time of acute retinal necrosis syndrome and explain the reason of different prognosis of acute retinal necrosis. Method: Three patients were examined by neurology and ophthalmology. Possible pathogenesis was analyzed. Results: The 3 patients were 37-year-old male, 49-year-old female and 47-year-old male respectively. After being presented at diagnosis, they had herpetic encephalitis associated with acute retinal necrosis syndrome and all the examinations are consistent with herpetic infection. Conclusion: The key to influence the vision is the vision correction at preliminary diagnosis and central retinal artery occlusion and pathogenesis in the acute phase may relate to chemotaxis ability of T cell. Keywords: Acute retinal necrosis; Herpes simplex virus; Herpetic encephalitis

Fulminant bilateral acute retinal necrosis syndrome associated with viral encephalitis: A case report.

Herpes simplex virus (HSV) is the most common cause of acute viral encephalitis. Acute retinal necrosis (ARN) is a rapidly progressing and potentially blinding eye disease that may be induced by HSV. The present case study reports the very rare case of a patient with herpes simplex encephalitis (HSE) combined with acute retinal necrosis (ARN). A 47-year-old woman was admitted to hospital with persistent high fever and somnolence for 5 days. Magnetic resonance imaging showed abnormal signals in the right medial temporal lobes, and HSV-1 was identified in the serum and cerebrospinal fluid. Five days later, despite treatment with intravenous acyclovir and partial improvement in consciousness, the patient suddenly developed blurred vision and bilateral visual pain. Fundus fluorescence angiography revealed bilateral vessel obstruction and flaky reduced fluorescence. ARN was diagnosed clinically. Dexamethasone was administered as an anti-inflammatory adjunct to intravenous acyclovir therapy. The visual acuity of the patient was reduced to mere light perception a further 4 days later. The present case indicates that HSE may be complicated with ARN, causing a reduction in visual acuity to mere light perception within a very short time.

Progressive outer retinal necrosis syndrome in the course of systemic lupus erythematosus

Progressive outer retinal necrosis syndrome (PORN) is a severe clinical variant of necrotizing herpetic chorioretinitis, which occurs almost exclusively in patients with advanced acquired immunodeficiency syndrome (AIDS). To date, only a few cases of PORN have been reported in patients, mostly among those who were immunocompromised. To our knowledge, only one case of PORN in a patient with systemic lupus erythematosus (SLE) has been described. We report the case of a 44-year old HIV-negative patient with lupus nephritis, whom was being treated by mycophenolate mophetil (MMF), arechin and prednisone. After 14 months of MMF therapy, the patient revealed PORN symptoms; and several months later, the patient developed Type B primary central nervous system lymphoma (PCNSL). PORN is usually compared to acute retinal necrosis (ARN) syndrome, because of having the same causative agent: varicella zoster virus (VZV). There are also some similarities in clinical findings. Our observation supports the hypothesis that PORN symptoms in HIV-negative patients can be an intermediate form between ARN and PORN, and can vary according to the patient's immune status.

Viral encephalitis complicated by acute retinal necrosis syndrome: A case report.

Acute retinal necrosis syndrome (ARN) is a viral infection characterized by focal retinal necrosis. Viral meningitis complicated by ARN is relatively rare. In the present case study, a 44-year-old male presented with fever, headache and mental disorder. After four days, the patient developed blurred vision. The patient was diagnosed with viral encephalitis complicated by bilateral ARN, based on the examination results. After treatment with antivirals and systemic glucocorticoids, the symptoms of the patient improved. Viral encephalitis may be an important risk factor for ARN. For a patient with viral encephalitis who experiences decreased visual acuity or vitreous opacification, the possibility of ARN should be considered.

Treatment of acute retinal necrosis syndrome

Treatment of acute retinal necrosis syndrome

Pattern of Acute Retinal Necrosis in a Referral Center in Tunisia, North Africa

Purpose: To describe the pattern of acute retinal necrosis (ARN) syndrome in a referral center in Tunisia.Methods: Retrospective review of the charts of 12 patients (12 eyes).Results: Necrotizing retinitis involved >50% of the retina in 33.3% of eyes. Polymerase chain reaction on aqueous humor sample identified herpes simplex virus-1 in 4 eyes (33.3%) and varicella zoster virus in 3 eyes (25%), and was negative in 5 eyes (41.7%). All patients received intravenous acyclovir, followed by oral antivirals. Follow-up ranged from 6 to 16 months. Retinal detachment (RD) occurred in 3 eyes (25%), but no patient developed bilateral ARN. Final visual acuity was 20/200 or worse in 7 eyes (58.3%). Delay in diagnosis (p = 0.015), macular involvement (p = 0.045), development of RD (p = 0.018), and 25–50% of retinal involvement (p = 0.045) were associated with a worse visual outcome.Conclusion: ARN carries poor visual prognosis in Tunisia.

Good visual outcome in an immunocompromised patient with bilateral acute retinal necrosis syndrome: A case report

Acute retinal necrosis (ARN) is an uncommon necrotizing, fulminant retinopathy caused by the herpes simplex virus types 1 or 2 or by the varicella zoster vírus with visually devastating consequences. Generally it occurs in patients who are systemically healthy, but occasionally occurs in immunocompromised host. We report a case of bilateral ARN in a patient with AIDS with a good final visual outcome.

Kyrieleis plaques in herpes zoster virus associated acute retinal necrosis

AbstractPurpose To present a case of unilateral acute retinal necrosis syndrome (ARNS) with associated Kyrieleis plaques.Methods A 56 year old male with recently diagnosed ARNS with necrotic lesions, extensive retinitis 360˚ around the arcades and multifocal lesions presented with decreased vision and floaters in his left eye. Anterior uveitis of 3+ cells, with mutton fat keratic precipitates and vitritis 2+ with severe haze settled down following anti‐viral and steroid treatment. Polymerase chain reaction from anterior chamber tap revealed presence of Herpes Zoster Virus.Results Kyrieleis plaques and segmented periarteritis appeared at presentation and spreaded in the first 2‐3 weeks whilst inflammation was settling down. They affected the majority of retinal arteries near the optic disc; however there was no evidence of sheathing of leakage of the arteries wall on fluorescein angiography.Conclusion Increased doses of steroids appear to control the inflammation. There was no association found between Kyreileis plaques and severity of inflammation.

Acute retinal necrosis (ARN) in the context of neonatal HSV-2 exposure and subconjunctival dexamethasone: case report and literature review

HSV-2 is an important cause of the acute retinal necrosis (ARN) syndrome in younger patients. We describe an atypical case of HSV-2 ARN in the context of neonatal exposure and subconjunctival steroid injection. Clinicians should be aware of the association of neonatal or congenital exposure to HSV-2 as a risk factor for this disease because early treatment may improve outcome and/or avoid involvement of both eyes.