Acute Retinal Necrosis Dr. Rathinam Sivakumar HOD - Uveitis Services Dr. Radhika. T Consultant, Uveitis Service Dr. Vedhanayaki Rajesh

Ocular History 27 year old male OD: defective vision, pain and redness since 15 days no specific systemic illness

First Presentation VA: OD 6/36, OS 6/6 IOP: OD 18mm Hg; OS 18mm Hg by NCT OD: granulomatous KP's on endothelium AC 3+ cells; flare 2+ AVF 3+ cells; retinal necrosis with sclerosed vessel OS: quiet eye

First Presentation – Lab Findngs Routine baseline investigations were performed and were within normal limits HIV Tridot -ve Vit. Tap : PCR +ve for VZV

Diagnosis Acute retinal necrosis induced by varicella-zoster virus

Treatment steroid with antibiotics e/d – tapering therapy homatropine e/d twice/day – 1 week Topical ganciclovir gel 3x/day oral valacyclovir 1gm 3x/day oral prednisolone tapered weekly from 40 mg/ week to 10mg (4 weeks) intravitreal gancyclovir (2mg / 0.1 ml)

Second Presentation – After 3 weeks VA: OD 6/9, OS 6/6 IOP: OD 10mm Hg; OS 18mm Hg by NCT OD: AC quiet; Healing Retinal necrosis OS: Quiet eye Patient was continued on oral valacyclovir

Third Presentation – After one Month VA: OD 5/60, OS 6/6 OD: AC – Occ. Cells fundus: retinal detachment (post ARN) pars plana vitrectomy +/- membrane peeling + endolaser + silicone oil implantation continued on oral valacyclovir

Final Presentation – After 1 Month BCVA: OD 6/9, OS 6/6 OD: AC – Quiet Fundus: silicone oil filled globe settled retinal detachment

Conclusion ARN is characterised by acute peripheral necrotising retinitis, retinal arteriolitis with severe vitritis It can be caused by VZV / HSV in both immunocompetent and compromised patients Retinitis progresses rapidly in the absence of treatment. Rhegmatogenous retinal detachment can occur from atrophic areas post retinal necrosis Intravitreal Gancyclovir and oral antiviral therapy are the best treatment options. Corticosteroids are initiated with anti-virals in tapering regimen