The authors of this retrospective study aimed to provide clinical outcomes in 62 eyes of 53 patients presenting with acute retinal necrosis. All eyes received intravenous acyclovir (10mg/kg tds) for 7-10 days followed by oral antiviral therapy (valaciclovir 1g tds or acyclovir 800mg five times a day). Seventy-two percent of patients were male with a mean age of 36 years. Eighty-three percent had unilateral involvement. In bilateral cases, the average duration to second eye involvement was 210 days. All presented with a main complaint of hazy vision. Two patients were HIV positive. Difference in visual acuity between initial (2.02 logMAR) and final visit (1.78 logMAR) was statistically significant. Fifty-two percent of eyes had 360 degrees of peripheral retinal involvement. Eighteen eyes had retinal detachment at presentation, while 23 eyes developed detachment during the course of the disease. Mean duration between onset of complaints and detachment was 71 days. Aqueous and vitreous samples revealed HSV in 19 and VZV in 28 eyes. No organisms were found in nine eyes. There was no significant difference between detachment rates in lasered versus nonlasered eyes. Thirty-two eyes required surgery (one for vitreous haze, 31 for retinal detachment). Recurrent detachment was seen in 14 of the 31 eyes. Extent of retinal involvement and time interval between onset of disease and start of treatment were significant parameters that affected the visual potential. The authors comment that antiviral therapy minimises progression of unilateral to bilateral disease, and eyes with less than 90% involvement had the best prognosis functionally. Early recognition and aggressive treatment is the cornerstone in managing this serious condition. 

Acute retinal necrosis: clinical features, management and outcomes – a 10 year consecutive case series.
Roy R, Pal B, Mathur G, et al.
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Saruban Pasu

Moorfields Eye Hospital, London, UK.

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