Elsevier

American Journal of Ophthalmology

Volume 206, October 2019, Pages 140-148
American Journal of Ophthalmology

Original Article
Risk of Rhegmatogenous Retinal Detachment in Acute Retinal Necrosis With and Without Prophylactic Intervention

https://doi.org/10.1016/j.ajo.2019.05.023Get rights and content

Purpose

To study whether preventive laser or preventive vitrectomy is able to lower the risk of rhegmatogenous retinal detachment (RRD) in patients with acute retinal necrosis (ARN).

Design

A retrospective, interventional case series.

Methods

We performed a retrospective study of 59 patients (63 eyes) with ARN treated in a single tertiary referral center. We analyzed different groups with either no prophylaxis, prophylactic laser, or prophylactic vitrectomy. Main outcome measure was incidence of RRD.

Results

Overall incidence of RRD was 44.4%, including 13% at presentation. In a crude analysis, the risk of RRD was highest in 33 patients with prophylactic laser (45.5%), lower in 15 patients with no prophylaxis (26.7%), and lowest in 7 patients with prophylactic vitrectomy (14.3%). Baseline best-corrected visual acuity differed between these groups, but zone and percentage of involved retina did not. In a multivariable model including prophylactic laser and ARN severity, only zone was predictive of RRD.

Conclusion

When correcting for severity of disease, we did not observe a reduction in the risk of RRD by prophylactic laser in eyes with ARN. Therefore, prophylactic laser may be abandoned. The role of prophylactic vitrectomy is still unclear, but deserves further investigation.

Section snippets

Patients and Study Design

This retrospective study was conducted at the University Medical Center Utrecht, Utrecht, the Netherlands, a tertiary referral center for patients with uveitis and ARN. We performed the study in accordance with the 1964 Declaration of Helsinki and its further amendments. Before the start of the study, the Institutional Review Board of University Medical Center Utrecht waived approval of the study protocol, since no experimental procedures were performed.

We included all patients with ARN that

Patient Characteristics

In total, 63 eyes of 59 patients were included, as 4 patients had bilateral involvement. Clinical characteristics at presentation are shown in Table 1. Mean age was 58.4 years and 50.8% of eyes were of male patients. Median BCVA was 20/100 (0.7 logMAR), with 15 eyes (23.8%) having a BCVA better than 20/50 and 3 eyes (4.8%) with or without light perception (LP). Median duration of symptoms before diagnosis was 14 days. Involved retina was limited to the periphery (zone 3) in 19.0% of eyes and

Discussion

In our Dutch tertiary referral center, prophylactic laser was included in the treatment protocol for ARN patients some 20 years ago. The basis for this intervention was a plausible hypothesis and the publications of Sternberg and associates19 and Crapotta and associates24 in which a protective effect was suggested. Since then no convincing evidence has been put forward and a report by the American Academy of Ophthalmology in 2017 concluded that the available evidence at that time did not

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