Older patients more often present with VZV or HSV-1 infections while younger patients more often present with HSV-2 infections. [eyewiki.aao.org]

Among other alternatives of antiviral management, foscarnet, brivudine, famcyclovir or valgancyclovir are present. [scielo.org.co]

In 9 cases the clinical presentation was that of a typical ARN. in 3 cases ARN was of the “mild-type” and in 3 cases lesions were multifocal involving initially the posterior pole resembling the clinical picture of PORN (progressive outer retinal necrosis [thieme-connect.com]

Retinal hemorrhage, if present is usually not very prominent. Kyrieleis' periarteriolar plaque may be seen in ARN.[7] Evaluation Acute retinal necrosis is a clinical diagnosis and treatment should not be delayed in a typical case. [ncbi.nlm.nih.gov]

• Inflammation

  Classically, posterior segment involvement includes vitreous inflammation, retinal vascular arteriolitis, and peripheral retinitis. [eyewiki.aao.org]

  Aggressive postoperative inflammation including fibrinous reaction may be noted. Despite retinal reattachment visual gain may be limited by optic atrophy and epiretinal membrane. [ncbi.nlm.nih.gov]

  We therefore suggest to avoid to add systemic steroids to the specific antiviral therapy but to treat inflammation by periocular steroids. [thieme-connect.com]

• Macula

  Optical coherence tomography of the macula and optic nerve head may be considered and may show cystoid macular edema/ epiretinal membrane or disc edema. [ncbi.nlm.nih.gov]

  There is an improvement of ocular fundus when compared to initial photo; optic disc is slightly pale, there is a notorious re-absorption of hemorrhages, macula lutea with inferior perifoveal exudation is less than 500 ìm of diameter (Photo 3). [scielo.org.co]

  IV q12h) Valganciclovir (900 mg twice daily orally for 3 weeks induction, then 450 mg twice daily po for maintenance) Antiviral agents administered intravitreally can provide beneficial adjunctive therapy, especially if retinitis is threatening the macula [eyewiki.aao.org]

• Photophobia

  […] arteritis.[6] Herpes group of viruses were noted in all the layers of the involved retina using electron microscopy.[6] History and Physical Patients will often present with rapid onset of ocular pain or periocular pain, pain on eye movement, redness, photophobia [ncbi.nlm.nih.gov]

  Signs and symptoms Patients with ARN typically present with acute onset of vision loss in one eye, which may be associated with redness, photophobia, pain, floaters, and flashes. Two-thirds of cases present with unilateral involvement. [eyewiki.aao.org]

• Retinal Hemorrhage

  Additional findings can include conjunctival injection, scleritis, increased intraocular pressure, sheathed retinal arterioles, retinal hemorrhage, optic disc edema, and retinal detachment. [ncbi.nlm.nih.gov]

  […] in its location.[3] Retinal hemorrhages due to occlusive vasculitis may be seen. [eyewiki.aao.org]

• Blurred Vision

  or blurred vision, and constriction of the visual field. [ncbi.nlm.nih.gov]

Infectious workup and fluoresceinic angiography were made and positive serologies for herpes virus types 1 and 2, without HIV, were found. [scielo.org.co]

Review the workup that should be considered in a patient with probable acute retinal necrosis. Explain how to treat a patient for acute retinal necrosis. [ncbi.nlm.nih.gov]

A diagnosis of acute retinal necrosis was made and treatment with intravenous valgancyclovir for two weeks and intra-vitreous triamcinolone for severe vasculitis, was given. Then a 3 months treatment with oral antiviral agents was prescribed. [scielo.org.co]

Treatment of Acute Retinal Necrosis Syndrome with Oral Antiviral Medications. Ophthalmology 2007, 114: 307–312. Aslanides IM, De Souza S, Wong DT, et al. Oral valacyclovir in the treatment of acute retinal necrosis syndrome. [eyewiki.aao.org]

Treatment / Management Immediate treatment of the patient is required and can be done in either the inpatient or outpatient setting. The goal is to decrease the incidence in the fellow eye. [ncbi.nlm.nih.gov]

PMID: 16996614 Bilateral necrotizing herpetic retinopathy three years after herpes simplex encephalitis following pulse corticosteroid treatment. Verma L, Venkatesh P, Satpal G, Rathore K, Tewari HK. Verma L, et al. [pubmed.ncbi.nlm.nih.gov]

The visual prognosis of ARN is poor and 64% of affected eyes achieve a final acuity of worse than 20/200 due to multiple complications including retinal detachment, optic neuropathy, macular abnormality, and retinal ischemia.[18] Visual outcomes may [ncbi.nlm.nih.gov]

Associated factors to bad visual prognosis in ARN are, diffuse retinal arteritis, retinal detachment and arterial occlusion. From literature it is also known a multi focused dotted pattern with a very bad prognosis5. [scielo.org.co]

Complications Many cases finally have less than 20/200 due to Retinal holes and tears Retinal detachment Proliferative vitreoretinopathy Vitreous hemorrhage Macular pucker Optic neuropathy- pallor of the optic disc Encephalitis Prognosis The visual outcome [eyewiki.aao.org]

Maghreb Med. 1995; (295): 54- Maghreb Medical Journal Country: Tunisia P-ISSN: 0330-258X Type of Publication: Case Reports Keywords: Retinal Necrosis Syndrome, Acute / Etiology Broad Subjects: Herpesvirus 3, Human ,pathogenicity ,Cytomegalovirus ,pathogenicity [vlibrary.emro.who.int]

Etiology ARN is believed to be caused by a viral infection. Most often the causative viral agent is either VZV or less commonly HSV. [eyewiki.aao.org]

Among ARN etiologic agents several members of herpes virus family have been found. [scielo.org.co]

Part 2: Histopathology and etiology. Ophthalmology. 1982 Dec;89(12):1317-25. [PubMed: 6298683] 7. Chawla R, Tripathy K, Sharma YR, Venkatesh P, Vohra R. Periarterial Plaques (Kyrieleis' Arteriolitis) in a Case of Bilateral Acute Retinal Necrosis. [ncbi.nlm.nih.gov]

Epidemiology This clinical entity is uncommon in the pediatric population. Most often it affects healthy, immunocompetent adults in their fifth to seventh decade. A clear racial or gender predilection has not been consistently demonstrated. [eyewiki.aao.org]

The most common agent is VZV.[2] Epidemiology It is often found in immunocompetent individuals. It affects men and women equally. Acute retinal necrosis tends to occur in older patient populations as VZV immunity wanes. [ncbi.nlm.nih.gov]

Pathophysiology Acute Herpetic Phase: Viral particles in the retina and vitreous provoke an intense inflammatory response. Retinal opacification corresponds with infiltration of the retina with viral particles and mononuclear cells. [eyewiki.aao.org]

It has also been seen with the American Caucasian populations that have HLA-DQw7, HLA-Bw62, and HLA-DR4.[3] Pathophysiology The virus infects retinal cells and causes necrosis to occur. [ncbi.nlm.nih.gov]

The rates of success in preventing retinal detachment are variable, and consensus does not exist on whether laser demarcation should be employed. [eyewiki.aao.org]

Lastly, prophylactic barrier laser photocoagulation posterior to active retinitis may be considered to wall off or prevent subsequent retinal detachment. [ncbi.nlm.nih.gov]

The prophylactic laser barrier in the first two weeks has been used to prevent rheumatic retinal detachment with good results; it can be associated with steroids in severe inflammatory processes. Interest conflict. [scielo.org.co]