Objective To investigate the long term efficacy of vitrectomy in the treatment of acute retinal necrosis syndrome (ARN).Methods The clinical data of 17 patients (19 eyes) with ARN underwent vitrectomy were retrospectively analyzed. The diagnosis of ARN was made by clinical symptoms, slit lamp and indirect ophthalmoscope examination. Preoperative best corrected visual acuity (BCVA) ranged from no light perception to 0.1 (only one eye with 0.1). Eighteen eyes had retinal detachment (RD). All 19 eyes underwent one to five times (on average of 2.8 times) conventional pars plana vitrectomy (PPV). 18/19 eyes (94.7%) underwent multiple times of PPV. The followup period ranged from 12 to 120 months with an average of 44 months.Results Complete retinal reattachment was achieved in 17/18 (88.9%) eyes at the next day after the first PPV. The major indications for second or more times PPV included removal of silicon oil, proliferative retinopathy and hypotony. Nine eyes had a BCVAge;0.1 during the followup, but only four eyes had a BCVAge;0.1 at the end of followup. The mean IOP of 19 eyes with silicone oil tamponade was 12.7 mm Hg（1 mm Hg=0.133 kPa）, and the mean IOP of 15 eyes without silicone oil tamponade was 5.1 mm Hg. All eyes had variable degrees of postoperative proliferative retinopathy, and eight eyes developed atrophy of eyeball at the end of the follow-up.Conclusion PPV has no long-term beneficial effects on ARN.
Objective To observe the clinical features of acute retinal necrosis syndrome (ARN).Methods The clinical data of 84 patients (98 eyes) with ARN were retrospective analyzed. The patietns had undergone the examinations of best visual acuity, intraocular pressure, Bscanning, slitlamp biomicroscope, preset lens, direct and (or) indirect ophthalmolscope,and trihedral reflector; fundus fluorecein angiography had been performed on the patients with clear refracting media. Some of the patients had undergone polymerase chain reaction (PCR) to dectet the types of the causative virus.Medication,laser photocoagulation,and vitreous surgery had been performed on the patients after the diagnosis was confirmed. The visual acuity and the change of ocular fundus had been followed up; the average followup was 24.1 months. Results The average age of the patients at the onset was 42.8 years with the bilateraleye rate of 16.6% and retinaldetachment rate of 57.1%. There were 53.5% and 35.5% patients had the final visual acuity of gt;0.02 after 6 and 12 months, respectively. Better prognosis was found in patients diagnosed within 2 weeks and second involved eye. Varicella zoster virus DNA was identified in 15 patients and herpes simplex virus 1 was found in 3.Conclusions ARN is an acute disease with high incidence of retinal detachment.Serious retinal vasculopathy always happens at the late stage, and the prognosis is poor. Diagnosis in early stage is important and application of PCR will do contribution to the right diagnosis.
Objective To evaluate the clinical features and treatment outcomes of acute retinal necrosis syndrome (ARNS) which caused by long-term usage of immunosuppressent drug. Methods The clinical data of 8 patients (12 eyes) with immunocompromised-related ARNS were retrospectively reviewed. The diagosis was made by medical history, slit-lamp microscopy, pre-set lenses check, serologic examination and fluorescein fundus angiography. The patients (2 males and 6 females) aged from 35 to 54 years, with the mean age of 44.2 years. Previous medical history included hematopathy (2 cases), thymus tumor (2 cases, one also with meningoencephalitis), meningoencephalitis (2 cases), systemic lupus erythematosus (1 case) and acute pneumonia (1 case). All patients received immunosuppressent therapy for a long time before ARNS occurred. The visual acuity was ＜0.05 (5 eyes, 41.7%), or 0.05-0.3 (3 eyes, 25.0%), or 0.3-1.0 (4 eyes, 33.3%). Those ARNS patients received antiviral therapy, laser photocoagulation and (or) surgery therapy. The mean followed-up period was 10.8 months (from 3 to 36 months). Results The eye sympotoms and uveitis of all patients were very mild, and their retinal vasculitis and retinal necrosis progressed slowly. Retinal vasculitis was involved in 4 quadrants (7 eyes), or 1-2 quadrants (2 eyes), or ＜1quadrant (3 eyes). Retinal necrosis extended from peripheral retina to mid- peripheral retina (10 eyes, 83.4%), or from peripheral retina to posterior pole (2 eyes, 16.6%). At the end of the follow-up period, the visual acuity of 7 eyes (58.3%) showed different degree of improvement. The follow-up visual acuity was ＜0.05 (4 eyes, 33.3%), or 0.05-0.3 (2 eyes, 16.6%), or 0.3-1.0 (6 eyes, 50%). Conclusions Immunocompromised ARNS patients had valid medical history and typical clinical features. However the eye sympotoms and uveitis were very mild, retinal vasculitis and retinal necrosis progressed slowly in this study. Early diagnosis and prompt therapy may save the visual acuity of those patients.
Objective To observe the therapeutic effects of ganciclovir (GCV) with different injection methods on experimental acute retinal necrosis (ARN). Methods The right eyes of 41 pigmented rabbits were infected by herpes simplex virus (HSV-1) (COS strain) to establish ARN animal model. After 24 and 72 hours, GCV was given by intravitreal injection (10 eyes), intravenous injection (11 eyes) and the intravitreal+intravenous injection (10 eyes); intravitreal injection of GCV and dexamethasone (6 eyes) was also included. Four eyes were not treated as the control. The dosage of GCV in intravitreal and intravenous injection was 800mu;g and 5mg/kg weight, respectively. Retina necrosis was observed and the grade was recorded 1-21 days after injection according to the grade standard of retinopathy. The maximum grades of retinal necrosis in different groups were compared. Results The grade of retinal necosis was 3.8 in the control group, and 0.2, 0.4, 0.8, and 2.2 in intravitreal injection, intravitreal+intravenous injection, intravitreal injection with GCV and dexamethasone, and intravenous injection, respectively, 24 hours after the model was set up. The effects of the first 3 groups were obviously better than the last group (P=0.003, 0.011, 0.045); while the difference among the first 3 groups were not significant (P=0.881、0.054、0.107). Seventy-two hours after the model was set up, the grades of retinal necrosis were above 1.4 in 4 groups, and the differences among the 4 groups were not apparent (P=0.214). Conclusions In the animal model of ARN, intravitreal injection with GCV can effectively decrease the grade of retinal necrosis. The difference among intravitreal injection, intravitreal+intravenous injection, intravitreal injection with GCV and dexamethasone, and intravenous injection is not significant.