Symptoma

Acute Retinal Necrosis

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

  • Macula

    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]

  • Corneal Edema

    Physical examination Anterior segment involvement may include episcleritis, scleritis, corneal edema, keratic precipitates, and anterior chamber inflammation. [eyewiki.aao.org]

  • Red Eye

    Laser may be difficult in view of painful red eye, severe media haze due to vitritis, posterior synechia, and cataract. Also, laser over the necrotic, swollen white retina may cause iatrogenic breaks. [eyewiki.aao.org]

  • Suggestibility

    An animal model of ARN suggests that involvement in the contralateral eye occurs via retrograde axonal transport to the hypothalamus and the contralateral retina. [eyewiki.aao.org]

  • HLA-DR4

    Risk factors Genetics are believed to play a role in an individual’s risk for ARN with antigen expression of: HLA-DQw7, HLA-Bw62, and HLA-DR4 in American Caucasian populations and HLA-Aw33, HLA-B44, and HLA-DRw6 in Japanese populations. [eyewiki.aao.org]

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]

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]

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]

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]

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]

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]