Case report “Acute Retinal Necrosis or not?”

Josh Zhaoxu Yuen* and Christopher Helpert

Introduction

Acute retinal necrosis (ARN) is a disease including epicleritis or scleritis, periorbital pain, uveitis, vitreous opacity, and necrotizing retinitis. This case looks like ARN except lacking necrotizing retinitis. The epidemiology of ARN is either sex (a slight higher rate on male), any race or any age group (most at 20-50 years). Some patient is immunosuppression (like AIDS) or subclinical immune dysfunction. The incidence of ARN in the UK is one case per 1.6 to 2.0 million populations per year [1]. ARN is responsible for 5.5% of uveitis cases in US. The most common cause of ARN is varicella-zoster virus (VZV). It accounts for 50% to 80% cases. HSV1, HSV2 [2, 3]. And rarely cytomegalovirus (CMV) and Epstein–Barr virus (EBV) are also involved [2, 4]. Dr. Muthiah report in 2007 “The at risk population for ARN is patients who have had previous zoster viral infections: chickenpox (70.6% of cases), shingles (29.2%) and zoster ophthalmicus (20.7%). The other risk factors identifi ed in this study were previous herpes simplex cold sores (25%) and HSV encephalitis (15.4%)” [1]. The other factors might involve into the pathogenesis of ARN are HLADQw7, HLA-Aw33, Phenotpe Bw62, DR4, DRw6 and B44 [5]. The symptoms of ARN are: photophobia, periorbital pain or redness, decreased vision, fl oaters, previous varicella/herpes zoster infections. The differential diagnoses of ARN are vitritis and intermediate uveitis, Behçet’s disease, endophthalmitis, toxoplasmosis, cytomegalovirus retinitis, Sarcoidosis, syphilis /lupus, peripheral hemorrhage exudative choroidapathy, and ocular ischemic syndrome (OIS). The treatment of ARN is antiviral therapy, prophylactic confl uent laser therapy and prophylactic vitrectomy.

Keywords: Acute Retinal Necrosis (ARN); Vitreous Hemorrhage (VH); Choroidal Hemorrhage (CH)

Published on: Aug 22, 2017 Pages: 30-36

Full Text PDF Full Text HTML DOI: 10.17352/2455-1414.000041
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