To determine the viral diagnosis and the outcome of eyes with acute retinal necrosis
(ARN) treated with intravenous acyclovir and oral prednisolone alone or combined with
early vitrectomy and intravitreal acyclovir lavage.
Nonrandomized, retrospective, interventional, comparative, consecutive series.
A cohort of 27 human immunodeficiency virus-negative patients with ARN comprising
24 unilateral and 3 bilateral cases.
Vitreous biopsy for viral diagnosis. Twenty eyes were treated with intravenous acyclovir
in combination with oral prednisolone (group A). Ten eyes were treated additionally
with early vitrectomy, intravitreal acyclovir lavage, laser demarcation of necrotic
retinal areas when feasible-with or without scleral buckling, and gas or silicone
oil tamponade (group B). Vitrectomy was performed in all cases of secondary rhegmatogenous
retinal detachment (RD).
Results of vitreous biopsy, rate of RD, rate of phthisis bulbi, and course of best-corrected
visual acuity (BCVA).
Varicella zoster virus (VZV) was detected in 26 eyes, followed by herpes simplex virus
(5 eyes), and Epstein-Barr virus (2 eyes, in conjunction with VZV). An RD developed
in more eyes in group A (18 of 20 eyes) than in group B (4 of 10 eyes; P = 0.007).
In 2 of 20 eyes in group A and in 0 of 10 eyes in group B, phthisis bulbi developed
without a significant difference between groups A and B. Mean BCVA (logarithm of the
minimum angle of resolution) at first visit was 1.09 (standard deviation [SD], 0.83),
and mean final BCVA was 1.46 (SD, 0.88) without significant difference between groups
A and B.
Varicella zoster virus is the leading cause of ARN. Visual prognosis is guarded. Early
vitrectomy with intravitreal acyclovir lavage was associated with a lower incidence
of secondary RD; however, it did not improve mean final visual acuity.