97th DOG Annual Meeting 1999
DIAGNOSIS AND THERAPY IN ACUTE RETINAL NECROSIS SYNDROME
B. Müller, K. H. Velhagen, U. Pleyer
Background: The acute retinal necrosis syndrome is a fulminate retinitis that may lead to retinal detachment, vascular obliteration and optic neuropathy with a poor visual outcome in otherwise immunocompetent patients.
Methods: A series of 10 consecutive patients (14 eyes) (age 15 to 66 years) with an acute retinal necrosis syndrome were follow 6 to 36 months. We present the results of the clinical evaluation for diagnostic and therapeutic modalities. The diagnosis was confirmed by detection of intraocular antibody synthesis against Herpes- Simplex Type 1 - Virus, Varizella-Zoster-Virus and Cytomegalovirus.
Results: Autochtone antiviral antibodies were found in 13 of 16 aqueous analysis confirming the diagnosis of ARN. Among 16 analysis antibodies were detected against VZV-Antibodies in 10 times, HSV-1 in 8 times and CMV in 4 times. 2 of 4 patients had a bilateral ARN retinitis at initial presentation. Two patients developed ARN after 12 and 24 months in the fellow eye. The visual acuity was 0.35 (SD 0.33) at initial presentation which decreased over an average follow up period to 0.18 (0.33). Two eyes developed a mild ARN with a visual acuity of 0.6 after 6 months at the lowest level. 4 eyes had a moderate decrease in visual acuity of 0.2 to 0.3 during the follow up period. 3 severely affected patients were observed leading to no light perception in 4 eyes during 12 month of follow up. All patients received high dose intravenous virusstatic and antiinflammatory therapy. Vascular obliteration is a common complication in ARN, Aspirin or iv heparin therapy was administered. A vitrectomy, silicone band encircling, endolaser photocoagulation and silicone oil instillation or gas tamponade (one patient) was performed for rhegmatogenous retinal detachment in 5 and as a preventive measure in 3 patients.
Conclusion: The detection of intraocular synthesized antiviral antibodies confirms the early diagnosis of ARN with high sensitivity and specificity. The acute retinal necrosis syndrome has a poor visual outcome despite aggressive therapy.
Department of Ophthalmology; Charitè-Campus Virchow-Hospital,
Humboldt-University of Berlin, Augustenburger Platz 1, 13353 Berlin