First Author: R.Kahloun TUNISIA
Co Author(s): W. Ammari O. Haj Taher A. Khlifi S. Attia R. Messaoud M. Khairallah 0 0 0 0 0 0 0 0 0
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To describe the clinical features and the visual outcome of acute retinal necrosis (ARN) syndrome in a referral center.
Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
The charts of 12 patients (12 eyes) with newly diagnosed ARN syndrome were retrospectively reviewed.
The mean age was 35.7 years (range: 17-70 years). Eight of the patients were men and 4 were women. All patients were immunocompetent. Peripheral retinitis was associated with macular involvement in 3 eyes (25%). Polymerase chain reaction (PCR) results showed Herpes simplex virus-1 in 4 eyes (33.3% ), Varicella-Zoster virus in 3 eyes (25% ), and were negative in 5 eyes (41.7% ). All patients were treated with intravenous aciclovir, followed by oral valaciclovir for a mean duration of 3.8 months. Intravitreal injections of ganciclovir were given in 2 eyes. The mean follow-up was 8.4 months (range, 6 to 16 months). During the follow-up, no patient developed ARN in the fellow eye, but retinal detachment (RD) occurred in 3 eyes (25%). Final visual acuity was 20/40 (0.3 log MAR) or better in three eyes (25%) and 20/200 (1 log MAR) or worse in seven eyes (58.3%). Factors associated with poor visual outcome were duration between onset and treatment > 14 days (p=0.015), macular involvement (p=0.045), development of RD (p=0.018) and 25-50% of retinal involvement (p=0 .045).
ARN carries a poor visual prognosis in Tunisia. RD developed in one-fourth of cases despite antiviral treatment. Early diagnosis and prompt management are mandatory to improve visual outcome.