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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [2]; Luke Rusowicz-Orazem, B.S.

Overview

Acute retinal necrosis is a type of retinitis which can be associated with viral infections.

It was first characterized in 1971.[1][2]

One study indicated an incidence of 1 per 1.6 to 2.0 million.[3]

Historical Perspective

Classification

  • Acute retinal necrosis (ARN) may be classified by staging and severity into the following:[7]
    • Acute stage: Occurs at onset of disease and usually progresses past acute classification after a few weeks.
      • Presents with coalescence of white, necrotic tissue in the peripheral retina.
      • Vaso-occlusive retinal vasculitis is usually present.
      • The optic nerve head of the affected eye will appear swollen, but the posterior pole will usually not be affected during the acute stage.
    • Late stage: Is the natural progression of the disease and will present differentiating characteristics after a few weeks up to a few months.
      • Characterized by a regression of the coalesced necrosis in the peripheral retina, presenting starkly contrasted necrotic/non-necrotic tissue and mild pigmentation scarring and increased vitreous debris
      • Retinal detachment, severe vision loss, and potential blindness in the affected eye is indicative of late stage ARN.
      • If the infection is bilateral, the second eye will usually present signs of ARN in the weeks and months following the initial symptom manifestation in the first eye.
  • Acute retinal necrosis can also be classified by severity into the following:[8]
    • Mild: Is used to characterize ARN that is stable and non-progressive.
    • Fulminant: ARN that is progressive and will usually lead to retinal detachment and further complications if untreated.

Pathophysiology

Pathogenesis

Genetics

  • There is evidence of genetic predisposition to Acute retinal necrosis:
    • For Caucasian populations: possessing the HLA-DQw7, HLA-Bw62, and HLA-DR4 antigens are correlated to genetic predisposition to ARN.[12]
    • For Japanese populations: possessing the HLA-Aw33, HLA-B44, and HLA-DRw6 antigens are correlated to genetic predisposition to ARN.[8]
  • Possession of the above antigens in their respective demographics are correlated to impaired immunity and increased predisposition to infection.

Associated Conditions

Causes

Differentiating Sandbox:Acute retinal necrosis from Other Diseases

Epidemiology and Demographics

Incidence

  • Research in the United Kingdom resulted in an estimated incidence of approximately 6.3 per 100,000 individuals.[23]
    • There is evidence that this incidence is underestimated due to biases in case adjudication and under-reporting of data.[3]
  • Worldwide, the increase of immunocompromised and aged populations in most countries evidences an increase in Acute retinal necrosis.

Age

  • Acute retinal necrosis (ARN) developed from Herpes simplex virus 1 and Varicella-zoster virus is most common among patients older than 50 years.[8]
  • Herpes simplex virus (HSV) 2 infection is more common among children and adolescents; the incidence of HSV-2 caused ARN is highest in children and young adults between age 9 and 22 years.

Gender

  • There is no gender predisposition to Acute retinal necrosis.

Race

  • There is no racial predisposition to Acute retinal necrosis.

Risk Factors

  • Risk factors for the development of Acute retinal necrosis (ARN) include the following:
    • For caucasian populations: possessing the HLA-DQw7, HLA-Bw62, and HLA-DR4 antigens are correlated to genetic predisposition to ARN.[12]
    • For Japanese populations: possessing the HLA-Aw33, HLA-B44, and HLA-DRw6 antigens are correlated to genetic predisposition to ARN.[8]
    • Experiencing encephalitis from herpes simplex virus[24]
    • Immunocompromise from prior or concurrent disease.[25]
    • Immunosuppresion from extended corticosteroid therapy.[26]

Screening

  • There is no established, diagnostic screening process for Acute retinal necrosis.

Natural History, Complications, and Prognosis

Natural History

  • Symptoms of Acute retinal necrosis (ARN) develop rapidly upon onset of pathogenic infection.[8]
  • The natural progression of ARN depends on whether the case is mild or fulminant.
  • Without treatment, ARN will usually progress to Bilateral acute retinal necrosis (BARN) within weeks to a few months.[7]
    • There are exceptions in which the disease spread from the affected to the previously unaffected eye occurred up to 17 years later, due to reactivation of latent viral infection.[28]

Complications

Prognosis

  • Without treatment, the prognosis for Acute retinal necrosis (ARN) varies:[8]
  • With treatment, the prognosis for ARN is good if the therapy is administered in the early stages and sustained until symptoms resolve.
    • Uncommonly, prognosis can worsen if the patient is immunocompromised and experiences a subsequent infection due to vulnerability from prolonged topical corticosteroid use.

Diagnosis

Diagnostic Criteria

The diagnosis of acute retinal necrosis is made when the following criteria are met:[33]

History

Patient history of prior or concurrent diseases, particularly those associated with Acute retinal necrosis pathogens, or sources of immunocompromise should be considered in the diagnosis of Acute retinal necrosis:[25]

Symptoms

Symptoms of Acute retinal necrosis include the following:[3]

Physical Examination

Physical examination for acute retinal necrosis is remarkable for the following:[8]

Laboratory Findings

Laboratory findings associated with Acute retinal necrosis are those used to determine the viral pathogen, obtained from aqueous humor or the vitreous.[8]

Imaging Findings

Key CT Findings for Acute Retinal Necrosis

CT imaging may reveal indicators of inflammation and infection by the causative pathogen for Acute retinal necrosis (ARN).[39]

Key MRI Findings for Acute Retinal Necrosis

MRI imaging may reveal the following indicators of Acute retinal necrosis:[39]

Electrocardiogram

  • There are no diagnostic electrocardiogram findings associated with Acute retinal necrosis.

Chest X Ray

  • There are no diagnostic chest x ray findings associated with Acute retinal necrosis.

Echocardiography or Ultrasound

  • There are no diagnositic echocardiography or ultrasound findings associated with Acute retinal necrosis.

Other Imaging Findings

Fundus Autoflourescence

Fundus Autoflourescence (FAF) is an imaging technique that examines flourophores in the neurosensory retina and the retinal pigment epithelium, presenting with the following findings indicative of Acute retinal necrosis:[41]

  • Hypoautoflourescence in the retina, in conjunction with hyperflourescent borders, is indicative of Acute retinal necrosis and atrophy of retinal pigment epithelium.[42]
    • Posterior extension of the hyperflourescent borders may be indicative of spreading inflammation and Acute retinal necrosis.
    • Hyperflourescence may also be indicative of reduced ability to block flourophores into the retina due to damage and degradation.[43]
  • FAF is advantageous to color photos due to the ability to more starkly contrast lesions with unaffected retinal tissue.
Fluorescein Angiography

Fluorescein angiographic images may indicate evidence of Acute retinal necrosis by displaying retinal vasculature and potential retinal hemorrhages, as well as white-yellow necrotic lesions.[44][45]

  • Fluorscein angiography can reveal optic nerve head leakage caused by intraocular inflammation from the pathogent responsible for ARN.[21]
  • Imaging may reveal occlusive vasculopathy and periarterial vascular sheathing.
Optical Coherence Tomography

Optical Coherence Tomography (OCT) imaging may indicate Acute retinal necrosis with the following:[46]

Other Diagnostic Studies

There are no other diagnostic studies associated with Acute retinal necrosis.

Treatment

Medical Therapy

  • Empiric antimicrobial therapy
  • Preferred regimen: Acyclovir 10 mg/kg IV q8h for 1-2 weeks followed by Acyclovir 400 mg PO bid for chronic maintenance
  • Alternative regimen (1): Acyclovir 10 mg/kg IV q8h for 1-2 weeks followed by Valacyclovir 1 g IV q8h for 6 weeks to several months followed by Acyclovir 400 mg PO bid for chronic maintenance
  • Alternative regimen (2), unresponsive: Foscarnet 1.2-2.4 mg/0.1 mL intravitreal injection 1-3 times per week AND (Ganciclovir 5 mg/kg IV q12 for 2 weeks followed by 5 mg/kg q24h for 5-7 weeks OR Foscarnet 60 mg/kg IV q8h for 2 weeks followed by 90-120 mg/kg IV q24h OR Cidofovir 5 mg/kg IV for 2 weeks followed by 5 mg/kg IV q2weeks) followed by (Acyclovir 400 mg PO bid for chronic maintenance OR Valganciclovir 900 mg PO qd for chronic maintenance)
  • Note: Ganciclovir is administered for patients with suspected CMV acute retinal necrosis. Whereas Foscarnet is administered for patients who are not immunocompromised
  • Pathogen-directed antimicrobial therapy
  • HSV or VZV
  • Preferred regimen: Acyclovir 10 mg/kg IV q8h for 1-2 weeks followed by Acyclovir 400 mg PO bid for chronic maintenance
  • Alternative regimen: Acyclovir 10 mg/kg IV q8h for 1-2 weeks followed by Valacyclovir 1 g IV q8h for 6 weeks to several months followed by Acyclovir 400 mg PO bid for chronic maintenance
  • Cytomegalovirus
  • Preferred regimen: Foscarnet 1.2-2.4 mg/0.1 mL intravitreal injection 1-3 times per week AND Ganciclovir 5 mg/kg IV q12 for 2 weeks followed by 5 mg/kg q24h for 5-7 weeks followed by Valganciclovir 900 mg PO qd for chronic maintenance

Surgery

Surgery is not the first-line treatment option for patients with Acute retinal necrosis; it is primarily indicated when there is risk of complications, including retinal detachment and tissue atrophy.[47]

Vitrectomy

Prophylactic Laser Retinopexy

Prevention

Primary Prevention

Preventing onset of Acute retinal necrosis is dependent on preventing the causative infection from Herpes simplex virus (HSV), Varicella-zoster virus (VZV), and Cytomegalovirus (CMV). Measures to prevent viral infection include the following:[51][52][53]

  • Avoiding oral and genital contact with individuals infected with HSV
  • Avoiding proximity to individuals infected with VZV to avoid contact with pathogenic respiratory droplets and fluid contact
  • Avoiding fluid contact with individuals infected with CMV

Secondary Prevention

While recurrence of Acute retinal necrosis is not completely preventable presently, administration of topical and intravitreal antiviral therapy targeted to the specific etiological cause of the disease can reduce the chance of recurrence.[5]

  • Application of antiviral therapy is more effective for prevention when administered as close to disease onset as possible.
    • Extensive, prolonged therapy is important in preventing spread of the disease to the unaffected eye.

Further prophylactic measures, such as vitrectomy, may be used in current Acute retinal necrosis patients to minimize the possibility of complications, including retinal detachment.[47]

See also

External links

References

  1. "eMedicine - Acute Retinal Necrosis : Article by Andrew A Dahl, MD". Archived from the original on 16 February 2008. Retrieved 2008-02-05.
  2. 2.0 2.1 Urayama A, Yamada N, Sasaki T: Unilateral acute uveitis with retinal periarteritis and detachment. Jpn J Clin Ophthalmol 1971; 25: 607.
  3. 3.0 3.1 3.2 3.3 Muthiah MN, Michaelides M, Child CS, Mitchell SM (2007). "Acute retinal necrosis: a national population‐based study to assess the incidence, methods of diagnosis, treatment strategies and outcomes in the UK". Br J Ophthalmol. 91 (11): 1452–5. doi:10.1136/bjo.2007.114884. PMC 2095441. PMID 17504853.
  4. 4.0 4.1 Young NJ, Bird AC (1978). "Bilateral acute retinal necrosis". Br J Ophthalmol. 62 (9): 581–90. PMC 1043304. PMID 708676.
  5. 5.0 5.1 5.2 5.3 Flaxel CJ, Yeh S, Lauer AK (2013). "Combination systemic and intravitreal antiviral therapy in the management of acute retinal necrosis syndrome (an American Ophthalmological Society thesis)". Trans Am Ophthalmol Soc. 111: 133–44. PMC 3868412. PMID 24385671.
  6. Hayasaka S, Asano T, Yabata K, Ide A (1983). "Acute retinal necrosis". Br J Ophthalmol. 67 (7): 455–60. PMC 1040094. PMID 6860612.
  7. 7.0 7.1 Gartry DS, Spalton DJ, Tilzey A, Hykin PG (1991). "Acute retinal necrosis syndrome". Br J Ophthalmol. 75 (5): 292–7. PMC 1042358. PMID 1645179.
  8. 8.00 8.01 8.02 8.03 8.04 8.05 8.06 8.07 8.08 8.09 8.10 8.11 Brydak-Godowska J, Borkowski P, Szczepanik S, Moneta-Wielgoś J, Kęcik D (2014). "Clinical manifestation of self-limiting acute retinal necrosis". Med. Sci. Monit. 20: 2088–96. doi:10.12659/MSM.890469. PMC 4226315. PMID 25356955.
  9. 9.0 9.1 Ganatra JB, Chandler D, Santos C, Kuppermann B, Margolis TP (2000). "Viral causes of the acute retinal necrosis syndrome". Am. J. Ophthalmol. 129 (2): 166–72. PMID 10682968.
  10. Grose C (2012). "Acute retinal necrosis caused by herpes simplex virus type 2 in children: reactivation of an undiagnosed latent neonatal herpes infection". Semin Pediatr Neurol. 19 (3): 115–8. doi:10.1016/j.spen.2012.02.005. PMC 3419358. PMID 22889540.
  11. Whitley, Richard; Kimberlin, David W.; Prober, Charles G. (2007). Human Herpesviruses: Biology, Therapy, and Immunoprophylaxis. Cambridge, UK: Cambridge University Press. ISBN 978-0511545313.
  12. 12.0 12.1 Holland GN, Cornell PJ, Park MS, Barbetti A, Yuge J, Kreiger AE, Kaplan HJ, Pepose JS, Heckenlively JR, Culbertson WW (1989). "An association between acute retinal necrosis syndrome and HLA-DQw7 and phenotype Bw62, DR4". Am. J. Ophthalmol. 108 (4): 370–4. PMID 2801857.
  13. 13.0 13.1 Coisy S, Ebran JM, Milea D (2014). "Progressive outer retinal necrosis and immunosuppressive therapy in myasthenia gravis". Case Rep Ophthalmol. 5 (1): 132–7. doi:10.1159/000362662. PMC 4036147. PMID 24926266.
  14. 14.0 14.1 14.2 "Facts About Uveitis | National Eye Institute".
  15. 15.0 15.1 "CMV retinitis: MedlinePlus Medical Encyclopedia".
  16. 16.0 16.1 16.2 Davis JL (2012). "Diagnostic dilemmas in retinitis and endophthalmitis". Eye (Lond). 26 (2): 194–201. doi:10.1038/eye.2011.299. PMC 3272204. PMID 22116459.
  17. Pikkel YY, Pikkel J (2014). "Acute retinal necrosis in childhood". Case Rep Ophthalmol. 5 (2): 138–43. doi:10.1159/000363130. PMC 4049010. PMID 24932179.
  18. Dart JK (1986). "Eye disease at a community health centre". Br Med J (Clin Res Ed). 293 (6560): 1477–80. PMC 1342247. PMID 3099921.
  19. Leibowitz HM (2000). "The red eye". N Engl J Med. 343 (5): 345–51. doi:10.1056/NEJM200008033430507. PMID 10922425.
  20. University of Michigan Eyes Have it (2009)http://kellogg.umich.edu/theeyeshaveit/red-eye/
  21. 21.0 21.1 Abu El-Asrar AM, Herbort CP, Tabbara KF (2009). "Differential diagnosis of retinal vasculitis". Middle East Afr J Ophthalmol. 16 (4): 202–18. doi:10.4103/0974-9233.58423. PMC 2855661. PMID 20404987.
  22. Witmer MT, Pavan PR, Fouraker BD, Levy-Clarke GA (2011). "Acute retinal necrosis associated optic neuropathy". Acta Ophthalmol. 89 (7): 599–607. doi:10.1111/j.1755-3768.2010.01911.x. PMID 20645925.
  23. Cochrane TF, Silvestri G, McDowell C, Foot B, McAvoy CE (2012). "Acute retinal necrosis in the United Kingdom: results of a prospective surveillance study". Eye (Lond). 26 (3): 370–7, quiz 378. doi:10.1038/eye.2011.338. PMC 3298997. PMID 22281865.
  24. Vandercam T, Hintzen RQ, de Boer JH, Van der Lelij A (2008). "Herpetic encephalitis is a risk factor for retinal necrosis". Neurology. 71 (16): 1268–74. doi:10.1212/01.wnl.0000327615.99124.99. PMID 18852442.
  25. 25.0 25.1 Moutschen MP, Scheen AJ, Lefebvre PJ (1992). "Impaired immune responses in diabetes mellitus: analysis of the factors and mechanisms involved. Relevance to the increased susceptibility of diabetic patients to specific infections". Diabete Metab. 18 (3): 187–201. PMID 1397473.
  26. Yamamoto JH, Boletti DI, Nakashima Y, Hirata CE, Olivalves E, Shinzato MM, Okay TS, Santo RM, Duarte MI, Kalil J (2003). "Severe bilateral necrotising retinitis caused by Toxoplasma gondii in a patient with systemic lupus erythematosus and diabetes mellitus". Br J Ophthalmol. 87 (5): 651–2. PMC 1771672. PMID 12714420.
  27. Matsuo T, Nakayama T, Koyama T, Koyama M, Matsuo N (1988). "A proposed mild type of acute retinal necrosis syndrome". Am. J. Ophthalmol. 105 (6): 579–83. PMID 2837090.
  28. Okunuki Y, Usui Y, Kezuka T, Takeuchi M, Goto H (2011). "Four cases of bilateral acute retinal necrosis with a long interval after the initial onset". Br J Ophthalmol. 95 (9): 1251–4. doi:10.1136/bjo.2010.191288. PMID 21242577.
  29. Liang ZG, Liu ZL, Sun XW, Tao ML, Yu GP (2015). "Viral encephalitis complicated by acute retinal necrosis syndrome: A case report". Exp Ther Med. 10 (2): 465–467. doi:10.3892/etm.2015.2557. PMC 4509005. PMID 26622338.
  30. Vukojević N, Popovic Suić S, Sikić J, Katusić D, Curković T, Sarić B, Jukić T (2006). "[Acute retinal necrosis]". Acta Med Croatica. 60 (2): 145–8. PMID 16848208.
  31. 31.0 31.1 McDonald HR, Lewis H, Kreiger AE, Sidikaro Y, Heckenlively J (1991). "Surgical management of retinal detachment associated with the acute retinal necrosis syndrome". Br J Ophthalmol. 75 (8): 455–8. PMC 1042429. PMID 1873262.
  32. 32.0 32.1 Lau CH, Missotten T, Salzmann J, Lightman SL (2007). "Acute retinal necrosis features, management, and outcomes". Ophthalmology. 114 (4): 756–62. doi:10.1016/j.ophtha.2006.08.037. PMID 17184841.
  33. Holland GN (1994). "Standard diagnostic criteria for the acute retinal necrosis syndrome. Executive Committee of the American Uveitis Society". Am. J. Ophthalmol. 117 (5): 663–7. PMID 8172275.
  34. Ford JR, Tsui E, Lahey T, Zegans ME (2013). "Question: Can you identify this condition? Acute retinal necrosis". Can Fam Physician. 59 (12): 1307, 1308–10. PMC 3860929. PMID 24336545.
  35. "American Academy of Ophthalmology".
  36. Silva RA, Berrocal AM, Moshfeghi DM, Blumenkranz MS, Sanislo S, Davis JL (2013). "Herpes simplex virus type 2 mediated acute retinal necrosis in a pediatric population: case series and review". Graefes Arch. Clin. Exp. Ophthalmol. 251 (2): 559–66. doi:10.1007/s00417-012-2164-8. PMID 23052715.
  37. Singh A, Preiksaitis J, Ferenczy A, Romanowski B (2005). "The laboratory diagnosis of herpes simplex virus infections". Can J Infect Dis Med Microbiol. 16 (2): 92–8. PMC 2095011. PMID 18159535.
  38. De Groot-Mijnes JD, Rothova A, Van Loon AM, Schuller M, Ten Dam-Van Loon NH, De Boer JH, Schuurman R, Weersink AJ (2006). "Polymerase chain reaction and Goldmann-Witmer coefficient analysis are complimentary for the diagnosis of infectious uveitis". Am. J. Ophthalmol. 141 (2): 313–8. doi:10.1016/j.ajo.2005.09.017. PMID 16458686.
  39. 39.0 39.1 Bert RJ, Samawareerwa R, Melhem ER (2004). "CNS MR and CT findings associated with a clinical presentation of herpetic acute retinal necrosis and herpetic retrobulbar optic neuritis: five HIV-infected and one non-infected patients". AJNR Am J Neuroradiol. 25 (10): 1722–9. PMID 15569737.
  40. Sergott RC, Belmont JB, Savino PJ, Fischer DH, Bosley TM, Schatz NJ (1985). "Optic nerve involvement in the acute retinal necrosis syndrome". Arch. Ophthalmol. 103 (8): 1160–2. PMID 4026646.
  41. Delori FC, Dorey CK, Staurenghi G, Arend O, Goger DG, Weiter JJ (1995). "In vivo fluorescence of the ocular fundus exhibits retinal pigment epithelium lipofuscin characteristics". Invest. Ophthalmol. Vis. Sci. 36 (3): 718–29. PMID 7890502.
  42. Freund, K. Bailey; Mrejen, Sarah; Jung, Jesse; Yannuzzi, Lawrence A.; Boon, Camiel J. F. (2013). "Increased Fundus Autofluorescence Related to Outer Retinal Disruption". JAMA Ophthalmology. 131 (12): 1645. doi:10.1001/jamaophthalmol.2013.5030. ISSN 2168-6165.
  43. Ward TS, Reddy AK (2015). "Fundus autofluorescence in the diagnosis and monitoring of acute retinal necrosis". J Ophthalmic Inflamm Infect. 5: 19. doi:10.1186/s12348-015-0042-3. PMC 4477008. PMID 26120371.
  44. Takei H, Ohno-Matsui K, Hayano M, Mochizuki M (2002). "Indocyanine green angiographic findings in acute retinal necrosis". Jpn. J. Ophthalmol. 46 (3): 330–5. PMID 12063045.
  45. "Fluorescein angiography: MedlinePlus Medical Encyclopedia".
  46. Suzuki J, Goto H, Minoda H, Iwasaki T, Sakai J, Usui M (2006). "Analysis of retinal findings of acute retinal necrosis using optical coherence tomography". Ocul. Immunol. Inflamm. 14 (3): 165–70. doi:10.1080/09273940600672198. PMID 16766400.
  47. 47.0 47.1 Shantha JG, Weissman HM, Debiec MR, Albini TA, Yeh S (2015). "Advances in the management of acute retinal necrosis". Int Ophthalmol Clin. 55 (3): 1–13. doi:10.1097/IIO.0000000000000077. PMC 4567584. PMID 26035758.
  48. 48.0 48.1 Luo YH, Duan XC, Chen BH, Tang LS, Guo XJ (2012). "Efficacy and necessity of prophylactic vitrectomy for acute retinal necrosis syndrome". Int J Ophthalmol. 5 (4): 482–7. doi:10.3980/j.issn.2222-3959.2012.04.15. PMC 3428546. PMID 22937510.
  49. 49.0 49.1 Kawaguchi T, Spencer DB, Mochizuki M (2008). "Therapy for acute retinal necrosis". Semin Ophthalmol. 23 (4): 285–90. doi:10.1080/08820530802111192. PMID 18584565.
  50. 50.0 50.1 Park JJ, Pavesio C (2008). "Prophylactic laser photocoagulation for acute retinal necrosis. Does it raise more questions than answers?". Br J Ophthalmol. 92 (9): 1161–2. doi:10.1136/bjo.2008.147181. PMID 18723739.
  51. "WHO | Herpes simplex virus".
  52. Charkoudian, Leon D. (2011). "Acute Retinal Necrosis After Herpes Zoster Vaccination". Archives of Ophthalmology. 129 (11): 1495. doi:10.1001/archophthalmol.2011.320. ISSN 0003-9950.
  53. "CMV | Overview | Cytomegalovirus and Congenital CMV Infection | CDC".