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

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

3. 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

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

6. Diagnosis
Acute retinal necrosis
induced by varicella-zoster virus

7. 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)

8. 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

9. 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

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

12. 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