Bilateral Acute Retinal Necrosis Research Articles

Bilateral acute retinal necrosis with choroidal detachment

A 42-year-old man with history of topiramate intake presented with sudden diminution of vision. He was diagnosed with bilateral panuveitis with retinitis and serous choroidal detachment, with ultrasound biomicroscopy revealing ciliary body effusion. Systemic investigations were negative for immunosuppression. Topiramate was stopped and the patient was started on oral valacyclovir and oral steroids 48 h after antiviral therapy. The patient responded well to the treatment leading to resolution of retinitis as well as choroidal detachment. This is a unique case of bilateral acute necrotizing retinitis and choroidal detachment, in which early recognition and prompt treatment led to a favorable outcome.

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.

Bilateral acute retinal necrosis associated with unilateral retinal detachment after COVID-19 infection - a case report

Bilateral acute retinal necrosis associated with unilateral retinal detachment after COVID-19 infection - a case report

Malpractice Cases Arising From Telephone Based Telemedicine Triage in Ophthalmology

ABSTRACT Purpose To determine the allegation, precipitating medical issue, and outcome of telephone triage focused malpractice litigation among ophthalmologists. Methods The WestLaw Edge database was reviewed using terms pertaining to ophthalmology and telemedicine. The search ranged from 4/7/30 to 1/25/22. Results Of the 510 lawsuits, 3.5% (18/510) met inclusion criteria. 94.5% (17/18) alleged delays in evaluation and/or treatment. 61.1% (11/18) alleged incorrect diagnoses, 38.9% (7/18) claimed improper discussion of risks or informed consent, and 5.6% (1/18) alleged delayed referrals. The precipitating medical issues included retinal detachment in 33.3% (6/18) of cases, post-procedure and post-trauma endophthalmitis in 33.3% (6/18) of cases, ocular trauma without endophthalmitis in 22.2% (4/18) of cases, and bilateral acute retinal necrosis and allergic reactions each accounting for 5.6% (1/18) of cases. Conclusion Telephone triage creates potential malpractice litigation. Delay in in-person clinical evaluation and alleged failure to inform patients of possible irreversible vision loss may lead to potential malpractice litigation. We suggest offering the option of same day in person evaluation and informing the patient how delay may lead to irreversible vision loss.

Bilateral Acute Retinal Necrosis From Ocular Syphilis in a Nonimmunocompromised Patient

Abstract Acute retinal necrosis (ARN) is an inflammatory condition of the eye usually caused by viral infection, predominantly herpes simplex virus or varicella-zoster virus. More rarely, noninfectious conditions or infection with other viral and nonviral pathogens can lead to ARN. Onset of disease, which may occur unilaterally or bilaterally, is usually rapid and characterized by a range of symptoms, including pain of eye movement, eye redness, light sensitivity, impaired vision, and narrowing of the visual field. While infectious ARN may develop in otherwise healthy individuals, those who are immunocompromised may be more susceptible to this eye pathology, especially patients who are infected with HIV. Left untreated, ARN can lead to permanent vision loss; thus, rapid identification of the specific etiology of ARN is crucial for implementing appropriate therapies. However, infection with rare pathogens in patients who are at risk for common causes of ARN can complicate diagnosis and treatment, highlighting the need for physicians to know the full range of possible etiologies for the differential diagnosis. We present a case of bilateral ARN in an immunocompetent woman who was infected with genital herpes simplex virus 2, and therefore at high risk of viral infection, but whose ARN was an example of ocular syphilis caused by the bacterial pathogen Treponema pallidum. A review of the literature on ocular syphilis is also discussed.

A Case of Bilateral Acute Retinal Necrosis and Optic Neuritis Secondary to HSV-2 Infection (1953)

A Case of Bilateral Acute Retinal Necrosis and Optic Neuritis Secondary to HSV-2 Infection (1953)

Bilateral acute retinal necrosis during treatment with alemtuzumab for multiple sclerosis

Alemtuzumab is a humanized monoclonal antibody used as a treatment of multiple sclerosis (MS) and chronic lymphocytic leukemia. It decreases T cell count leading to significant immunosuppression, with increased risk of systemic and ocular infections. Herein, we report a unique case of bilateral acute retinal necrosis (ARN) caused by varicella-zoster virus (VZV) in a patient affected by MS under treatment with alemtuzumab. A 36-year-old man with a relapsing-remitting MS under treatment with alemtuzumab developed bilateral visual loss. Anterior segment examination displayed granulomatous keratic precipitates and 3+ cells in the anterior chamber, while fundoscopy showed bilateral 1+ vitritis and peripheral retinal necrosis, complicated by retinal detachment in the left eye. The high viral load for VZV in aqueous humor samples had a univocal interpretation for viral reactivation. In addition to systemic therapy with acyclovir, the patient was treated with bilateral intravitreal injections of foscarnet and underwent pars-plana vitrectomy and silicone oil tamponade for retinal detachment in the left eye. This report shows a unique case of bilateral ARN caused by VZV associated with alemtuzumab. Any visual loss in MS patients under biologic therapy should not be underestimated, performing an accurate differential diagnosis with optic neuritis.

BILATERAL ACUTE RETINAL NECROSIS: A Case Series.

To investigate the clinical characteristics and visual outcome of bilateral acute retinal necrosis. The study included 30 patients (60 eyes) who were diagnosed with bilateral acute retinal necrosis. The medical records were reviewed. Twenty-five patients developed the disease in the contralateral eye within 5 months and 5 patients at >2 years after the initial onset. At presentation, 14 of 21 eyes suffered from retinal necrosis of more than 180° in the initially affected eye, whereas 3 of 22 eyes suffered it in the later-affected eye. Retinal detachment occurred in 23 of the 27 initially affected eyes and in 5 of the 27 later-affected eyes. The mean logarithm of the minimum angle of resolution best-corrected visual acuity decreased from 2.0 ± 1.1 (Snellen equivalent counting fingers) to 2.2 ± 1.0 (Snellen equivalent counting fingers) in the initially affected eyes after a follow-up of 34.1 ± 48.2 months (P = 0.529), and improved from 0.5 ± 0.4 (Snellen equivalent 20/66) to 0.3 ± 0.4 (Snellen equivalent 20/40) in the later-affected eyes after a follow-up of 21.2 ± 23.3 months (P = 0.005). Bilateral acute retinal necrosis usually occurs in the contralateral eye within a few months, but sometimes after several years. Inflammation and retinal necrosis are less severe in the later-affected eye, with less retinal detachment and a better visual outcome.

Bilateral Acute Retinal Necrosis and Encephalomalacia Due to Herpes Simplex Virus Infection in a Premature Infant

Bilateral Acute Retinal Necrosis and Encephalomalacia Due to Herpes Simplex Virus Infection in a Premature Infant

Bilateral Acute Retinal Necrosis: Clinical Features and Outcomes in a Multicenter Study

ABSTRACTPurpose: To describe clinical features and outcome in bilateral acute retinal necrosis (BARN).Methods: Observational retrospective longitudinal review of ocular findings.Results: Thirty eyes of 15 patients (age 44.1 ± 15.8). Delay of involvement between eyes was 57.2 ± 105.2 months (median 3, range 0.5–360). Herpes simplex virus (HSV)-1 was the most frequent (20 eyes, 66.6%), followed by HSV-2 (five eyes, 16.7%) and varicella zoster virus (VZV, four eyes, 13.3%). Visual acuity worsened in 7 (23%) eyes, improved in 4 (13%), and remained stable in 19 (63%). Major complications included retinal detachment (11 eyes, 36%), optic atrophy (11 eyes, 33%), proliferative vitreoretinopathy (four eyes, 13.3%), neovascular glaucoma (four eyes, 13.3%), phthisis bulbi (three eyes, 10%). Symptoms-to-referral average time was 2.7 ± 1.0 weeks (range 1–4).Conclusions: In our study BARN was associated with severe visual outcome and high rate of ocular complications. Although BARN is a rare disease, the course is aggressive, regardless prompt referral in tertiary-care uveitis centers.

Comparing Treatment of Acute Retinal Necrosis With Either Oral Valacyclovir or Intravenous Acyclovir

To compare the visual outcomes of patients with acute retinal necrosis (ARN) treated initially with intravenous acyclovir vs oral valacyclovir therapy. Retrospective, comparative, interventional case series. Sixty-two patients (68 eyes) with ARN, treated at Moorfields Eye Hospital (United Kingdom) between 1992 and 2016, were identified through the hospital's electronic database. Exclusion criteria included insufficient patient records or follow-up (<150days). Fifty-six patients had unilateral ARN, while 6 had bilateral ARN. Patients who received intravenous acyclovir on diagnosis (n= 33) were compared with patients treated with oral valacyclovir (n= 29) across outcomes including best-corrected visual acuity, retinal detachment, severe vision loss, and other complications. The impact of adjunctive intravitreal antiviral and prophylactic barrier laser treatment was also assessed. Change in best-corrected visual acuity was not significantly different for eyes treated initially with intravenous therapy vs oral therapy over 5 years of follow-up data (P= .16). There was no difference in the rates of severe vision loss between the 2 groups (46% and 59%, respectively, P= .18), or of those eyes retaining good vision (28% vs 31%, respectively, P=.80). Retinal detachment occurred in 63% of cases and did not differ across treatment groups (62% vs 66%, respectively, P= .67). Barrier laser and intravitreal therapy had no effect on retinal detachment rate in either group. Oral valacyclovir is clinically equivalent to intravenous therapy in the management of ARN. Oral valacyclovir as an outpatient therapy-with or without intravitreal foscarnet-can therefore be considered as an acceptable alternative to inpatient therapy required for intravenous treatment.

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.

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.

Bilateral acute retinal necrosis due to varicella zóster virus in an elderly patient

Case reportThe case is reported of acute retinal necrosis with bilateral involvement due to varicella zoster virus in a 77 year-old man. Polymerase chain reaction (PCR) of aqueous humor was positive for varicella zoster virus (VZV). He developed a Kyrieleis’ vasculitis a month after starting the treatment, when the PCR analysis was negative. DiscussionPCR is a quick and safe technique, with a high sensitivity and specificity of 97%, useful to diagnose and monitor the viral activity. The intervention must be urgent, due to the dramatically rapid evolution. Oral famciclovir oral is good alternative owing to its bioavailability.

The clinical features of 10 cases of acute retinal necrosis complicated by viral encephalitis

To investigate the clinical features of acute retinal necrosis (ARN) complicated by viral encephalitis. Ten cases of ARN complicated by viral encephalitis were treated in the Department of Ophthalmology, Beijing Tongren Hospital from November 2013 to August 2014. Clinical manifestation, especially the fundus characteristics, was summarized. In the10 patients (19 eyes; 6 men and 4 women) with an age of (40.1 +/- 13.44) years, 1 patients had unilateral ARN, and 9 patients had bilateral ARN. The visual acuity was no light perception in 9 eyes, light perception to hand motion in 7 eyes, 0.05 in 1 eye, 0.2 in 1 eye, and 0.3 in 1 eye. Seven cases suffered ARN during the onset of viral encephalitis, and other cases suffered ARN at 2 to 3 months after the recovery of viral encephalitis. Seventeen eyes had mild to moderate vitreous opacity, and 2 eye shad severe vitreous opacity. Sixteen eyes had focal (1 or 2 quadrants) retinal necrosis, and 2 eyes had massive ( > 2 quadrants) retinal necrosis. Occlusive vasculitis obviously occurred in 18 eyes. Sixteen eyeshad retinal detachment. All affected eyes had early optic nerve atrophy. ARN can occur during the onset of viral encephalitis or after the recovery of viral encephalitis. The clinical features of ARN complicated by viral encephalitis may be generally mild to moderate vitreous opacity,small range retinal necrosis foci, early and severe optic atrophy, and occlusive retinal vasculitis.

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.

Neonatal Herpes Simplex Virus Type-1 Central Nervous System Disease With Acute Retinal Necrosis

We report a case of neonatal herpes simplex virus (HSV)-1 central nervous system disease with bilateral acute retinal necrosis (ARN). An infant was presented at 17 days of age with focal seizures. Cerebrospinal fluid polymerase chain reaction was positive for HSV-1 and brain magnetic resonance imaging showed cerebritis. While receiving intravenous acyclovir therapy, the infant developed ARN with vitreous fluid polymerase chain reaction positive for HSV-1 necessitating intravitreal foscarnet therapy. This is the first reported neonatal ARN secondary to HSV-1 and the first ARN case presenting without external ocular or cutaneous signs. Our report highlights that infants with neonatal HSV central nervous system disease should undergo a thorough ophthalmological evaluation to facilitate prompt diagnosis and immediate treatment of this rapidly progressive sight-threatening disease.

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.

Bilateral acute retinal necrosis after herpetic meningitis

PurposeThe report of a case of bilateral acute retinal necrosis after herpetic meningitis.Case reportA 47-year-old man was admitted with the chief complaint of persistent high fever and transient loss of consciousness. Although his general condition improved after intravenous acyclovir administration, the patient presented with visual loss in both eyes 4 days after admission. Visual acuity in his right eye was 20/200 and his left eye had light perception alone. Both eyes showed panretinal arteritis diagnosed as acute retinal necrosis. Panretinal photocoagulation was performed for both eyes. Progression of retinal detachment was prevented in both eyes; however, visual acuity of the left eye was totally lost because of neovascular glaucoma. Visual acuity of the right eye recovered to 20/20.ConclusionAlthough cases of bilateral acute retinal necrosis have been reported after herpetic encephalitis, this condition is rare after herpetic meningitis. Prophylactic acyclovir therapy and early panretinal photocoagulation may prevent retinal detachment and improve the prognosis. Neurologists and ophthalmologists should be aware that not only herpetic encephalitis but also herpetic meningitis can lead to acute retinal necrosis within a very short interval.

Spontaneous Resolution of Intravitreal Steroid-Induced Bilateral Cytomegalovirus Retinitis

A 73-year-old woman underwent vitrectomy and intravitreal triamcinolone acetonide (IVTA) of the right eye and cataract surgery with IVTA of the left eye, for bilateral diabetic macular edema. The patient presented with visual loss in both eyes three-months postoperatively. The fundoscopic examination revealed white-yellow, necrotic peripheral lesions in the superotemporal quadrant of both eyes. Although bilateral acute retinal necrosis was suspected, azotemia resulting from diabetic nephropathy limited the use of acyclovir. Antiviral treatment was not started. A sample of the aqueous humor for polymerase chain reaction (PCR) analysis was obtained. One week later, the PCR results indicated the presence of cytomegalovirus (CMV). Since the retinal lesions did not progress and did not threaten the macula, the patient was followed without treatment for CMV. The retinal lesions progressively regressed and completely resolved in both eyes by six months of follow-up. Patients with IVTA-induced CMV retinitis may not require systemic treatment with ganciclovir.