Visual outcome and poor prognostic factors in acute retinal necrosis syndrome
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Visual outcome and poor prognostic factors in acute retinal necrosis syndrome Mora Paolo 1 & Zola Marta 2 & Favilla Stefania 3 & Tagliavini Viola 1 & Calzetti Giacomo 1 & Carta Arturo 1 & Gandolfi Stefano 1 & Guex-Crosier Yan 2 Received: 11 December 2019 / Revised: 1 April 2020 / Accepted: 9 April 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objective To evaluate the impact of selected clinical parameters on the mid-/long-term visual outcome of patients with acute retinal necrosis (ARN) Design A retrospective cohort study Methods Setting Two University Hospitals (Parma, Italy; Lausanne, Switzerland). Participants Thirty-nine non-HIV patients (39 eyes) with ARN, as confirmed by polymerase chain reaction on intraocular samples. The following potential predictors were tested using linear regression models: age, sex, etiology, best-corrected visual acuity (BCVA) on admission, delay between ARN symptom onset and treatment initiation, and surgery (performed or not). Main outcome BCVA at the final follow up Results Thirty-nine of 39 non-HIV patients (22 men and 17 women; mean age, 50 years) diagnosed with ARN were enrolled in the study. Etiologies were: varicella-zoster virus in 25 eyes (64%), herpes simplex viruses in the remaining 14 eyes. The average follow-up duration was 19 ± 13 months. All patients had undergone systemic antivirals; surgery was performed in 16 eyes. The mean delay between onset of visual symptoms and antiviral treatment initiation was 15 ± 31 days (range, 1–180 days). The mean BCVA at baseline was 0.83 ± 0.75 logMAR, while the mean final BCVA was 0.75 ± 0.81 logMAR. Both initial BCVA and treatment delay (TD) were significantly correlated with the final BCVA (p < 0.05). Conclusions Initial BCVA and TD seem to be significant predictors of mid-/long-term visual outcome in non-HIV patients affected by ARN. Keywords Acute retinal necrosis (ARN) . Visual outcome . Predictors . Treatment
Introduction Acute retinal necrosis (ARN) is an uncommon but potentially blinding ocular inflammatory syndrome that most commonly affects otherwise healthy, non-HIV adults, with no predilection for gender or race. Whether considered an independent clinical entity, or as part of the spectrum of necrotizing * Guex-Crosier Yan [email protected] 1
Ophthalmology Unit, University Hospital of Parma, Parma, Italy
2
Department of Ophthalmology, Jules-Gonin Eye Hospital, University of Lausanne, Fondation Asile des Aveugles, Lausanne, Switzerland
3
Independent Researcher, on behalf of the Ophthalmology Unit, University Hospital of Parma, Parma, Italy
herpetic retinopathies, ARN has clear causative agents and diagnostic criteria, as formerly described by Holland [1], Ganatra et al. [2], and Hillenkamp et al. [3]. ARN is a developing full-thickness retinal necrosis caused by intraocular active replication of herpes viruses (simplex and zoster) or cytomegalovirus (CMV). The latter typically affects highly immunocompromised subjects who may also experience the clinical variant progre
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