Acute retinal necrosis (ARN) is a rare cause of uveitis. This paper aims to outline the clinical features of 12 patients with ARN in a referral centre in Tunisia, North Africa. A retrospective review of case notes was carried out. The extent of retinal necrosis was labelled as mild if <25%, moderate if 25-50% and severe if >50%. The treatment protocol consisted of IV acyclovir for 7-10 days followed by oral acyclovir for at least 12 weeks. Intravitreal gancyclovir was used when systemic antivirals were contraindicated. Oral steroids were added when the retinitis had regressed or been stable for several days. Polymerase chain reaction (PCR) on aqueous humour was done in all patients allowing for identification of the causative agent in 54.5%. HSV-1 was found in 33.3%, VZV in 25% while no HSV-2 or CMV were isolated. The authors note that the combination of systemic and intravitreal antiviral therapy seems to be superior to systemic antiviral treatment alone, in terms of visual prognosis and retinal detachment occurrence. In this case series, retinal detachment occurred only in eyes with more than or equal to 25% of retinal involvement. A total of 58.3% of patients had a final VA of 20/200 or worse. Poor visual outcome was associated with the following: duration between symptoms and treatment initiation more than 14 days, macular involvement, development of retinal detachment and retinal involvement of 25-50%. The use of oral steroids prior to antiviral treatment lowered the speed of retinitis healing. This paper is the first of its kind to describe features of acute retinal necrosis from North Africa. 

Pattern of acute retinal necrosis in a referral center in Tunisia, North Africa.
Khochtali S, Abroug N, Kahloun R, et al.
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Saruban Pasu

Moorfields Eye Hospital, London, UK.

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