Original ArticleRisk of Rhegmatogenous Retinal Detachment in Acute Retinal Necrosis With and Without Prophylactic Intervention
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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Cited by (34)
Surgical Outcomes of Acute Retinal Necrosis–Related Retinal Detachment in Polymerase Chain Reaction–Positive Patients: A Single-Center Experience
2022, Ophthalmology RetinaCitation Excerpt :Similar to 4% found by Butler et al,9 11.8% of the patients in our cohort had ≥20/40 VA at the final follow-up (this is compared with 53% in the non-RD group of the aforementioned cohort study). Early vitrectomy before ARN-related RD with endolaser has been suggested as a strategy to avoid RD and improve visual outcomes, although documented outcomes have been inconsistent.8,11,13 Future studies examining optimal management of the complications of ARN (i.e., optic atrophy, macular atrophy, and severe cystoid macular edema secondary to occlusive vasculitis) are needed.
Risk Factors for Retinal Detachment in Acute Retinal Necrosis
2022, Ophthalmology RetinaCitation Excerpt :These demographic differences did not, however, seem to confer a greater risk of RD. Of note, the proportions of eyes with VZV- and HSV-ARN that developed RD were comparable, and the Kaplan-Meier survival estimate showed similar RD-free survival for both viral etiologies. Some studies have observed a greater risk of RD with VZV-ARN,13 though others, like our study, have not observed a statistical difference between these groups.15 The longer mean time to RD in our study (174 days) compared with the means found in other studies (showing a range of 65 to 74 days)9,12 may be influenced by our longer follow-up time or could reflect a therapeutic effect of current treatment protocols with the aggressive use of intravitreal antivirals.
Treatment outcomes of PCR-positive acute retinal necrosis
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