Acute Retinal Necrosis: A Multicenter Study on Viral Etiology, Characteristics and Risk Factors for Visual Loss and Retinal Detachment
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Yes
Purpose
To investigate the clinical characteristics and factors associated with specific viral pathogens, severe visual impairment (SVI), and retinal detachment (RD) in patients with acute retinal necrosis (ARN)
Methods
Retrospective multicenter cohort study. Patients with ARN who underwent aqueous or vitreous polymerase chain reaction (PCR) testing were included. Multivariable mixed-effects Poisson regression identified factors associated with viral pathogens and SVI. A mixed-effects parametric survival-time model assessed RD risk factors.
Results
A total of 56 patients (65 eyes) with ARN were included, with a mean age was 39.9 ± 23.2 years. Varicella zoster virus (VZV) was the most common pathogen (30.8%), followed by Herpes simplex virus (HSV) (13.8%), Cytomegalovirus (CMV) (10.8%), Epstein-Barr virus (EBV) (9.2%), and human herpesvirus (HHV) (3.0%). Co-infections were observed in 20% of eyes. CMV-ARN was associated with wedge-shaped retinitis (aPR 4.19) and immunocompromised status (aPR 8.8). Younger age and optic disc edema (aPR 5.41) were correlated with HSV-ARN. SVI was related to zone 1 involvement (aRR 4.2), immunocompromised status (aRR 2.8), and RD (aRR 4.8). RD incidence increased in cases of VZV-ARN, with retinitis affecting 2-3 quadrants and immunocompetent patients.
Conclusion
VZV was the predominant viral pathogen. Wedge-shaped retinitis and immunocompromised status were associated with CMV-ARN, which suggests changing antiviral treatment to systemic Ganciclovir.Early and aggressive intervention is essential in VZV cases, particularly when retinitis involves 2-3 quadrants and in immunocompetent individuals, to reduce the risk of RD.
Conflict of interest
No
1
Last name
SOITONG
Initials of first name(s)
P
Department
Phramongkhutklao hospital
City
Bangkok
Country
Thailand
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