Andrew Dorman1,2, Mark Donaldson1,3
Purpose: To report the prognostic indicators of Acute Retinal Necrosis (ARN) and describe
outcomes of antiviral, antithrombotic, corticosteroid and laser treatments.
Method: Retrospective case series of patients diag- nosed with ARN from three major ophthalmology clinics from 1997-2017. Primary outcomes included ﬁnal VA, severe VA loss (≥1.00logMAR) and retinal detachment (RD).
Results: Fifty eyes of forty-six patients were diag- nosed with ARN. Induction therapy with intravenous acyclovir was administered in 90% of eyes. Induction therapy ≥13days did not decrease the incidence of severe VA loss. Intravitreal antiviral therapy was administered in 23 eyes with no signiﬁcant inﬂuence on the incidence of RD or severe vision loss. Mainte- nance antiviral medication was administered in 96% of eyes (50% received >13 weeks). At ﬁnal follow- up, 40% of eyes had severe vision loss (range:- 0.08-+3.0logMAR). Forty-six percent developed RD. RAPD, zone and extent of retinitis and RD were prognostic of ﬁnal VA. Antithrombotic therapy was administered in 25/50eyes and associated with lower incidence of severe VA loss (P = 0.027) and better ﬁnal VA (P = 0.040). Laser retinopexy was performed in 40% of eyes with no signiﬁcant effect on RD inci- dence (P = 0.901) or severe VA loss (P = 0.451).
Conclusions: ARN has a high incidence of RD and poor visual outcomes. Prognostic indicators include RAPD, zone and extent of retinitis and development of RD. Induction antiviral medication is appropriate for at least 12days. Systemic steroids should be tapered over ≥13weeks. Antithrombotic medication is associ- ated with improved outcomes. Laser retinopexy does not reduce the incidence of RD or severe vision loss.
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