Acute retinal necrosis: Difference between revisions

Latest revision as of 11:45, 15 February 2021

Background

Definition:
- Well-demarcated retinal necrosis on peripheral retina
- Rapid progression of necrosis
- Circumferential spread
- Occlusive vasculopathy
- Vitreal and aqueous inflammation
On the spectrum of necrotizing herpetic retinopathy, with progressive outer retinal necrosis on the other end of the spectrum

Differential Diagnosis

Most commonly HSV and VZV, though CMV also possible

Clinical Manifestations

Starts as anterior uveitis (painful, red eye with vision loss) that progresses to retinal necrosis
High rates of retinal detachment and blindness

Management

Directed by causative organism
Involvement of Ophthalmology
Typically requires intravenous ± intravitreal acyclovir, stepped down to oral valacyclovir after 7 to 14 days, to complete 3 months
- Sometimes intravitreal ganciclovir or foscarnet is added
May require steroids, usually added after 24 hours of antiviral therapy
May require vitrectomy or laser therapy

@@ Line 1: / Line 1: @@
-== Background ==
+==Background==
-* Definition:
-** Well-demarcated retinal necrosis on peripheral retina
-** Rapid progression of necrosis
-** Circumferential spread
-** Occlusive vasculopathy
-** Vitreal and aqueous inflammation
+*Definition:
-== Differential Diagnosis
+**Well-demarcated retinal necrosis on peripheral retina
-* Most commonly [[HSV]] and [[VZV]], though [[CMV]] also possible
+**Rapid progression of necrosis
+**Circumferential spread
+**Occlusive vasculopathy
+**Vitreal and aqueous inflammation
+*On the spectrum of [[necrotizing herpetic retinopathy]], with [[progressive outer retinal necrosis]] on the other end of the spectrum
+==Differential Diagnosis==
-== Clinical Manifestations ==
-* Starts as anterior uveitis (painful, red eye with vision loss) that progresses to retinal necrosis
-* High rates of retinal detachment and blindness
+*Most commonly [[HSV]] and [[VZV]], though [[CMV]] also possible
-== Management ==
-* Directed by causative organism
+==Clinical Manifestations==
-* Involvement of Ophthalmology
-* Typically requires intravenous ± intravitreal [[Is treated by::acyclovir]], stepped down to oral [[valacyclovir]]
+*Starts as anterior uveitis (painful, red eye with vision loss) that progresses to retinal necrosis
-* May require steroids
+*High rates of retinal detachment and blindness
-* May require vitrectomy or laser therapy
+==Management==
+*Directed by causative organism
+*Involvement of Ophthalmology
+*Typically requires intravenous ± intravitreal [[Is treated by::acyclovir]], stepped down to oral [[valacyclovir]] after 7 to 14 days, to complete 3 months
+**Sometimes intravitreal [[ganciclovir]] or [[foscarnet]] is added
+*May require steroids, usually added after 24 hours of antiviral therapy
+*May require vitrectomy or laser therapy
+==Further Reading==
+*Advances in the Management of Acute Retinal Necrosis. ''Int Ophthalmol Clin''. 2015;55(3):1–13. doi: [https://doi.org/10.1097/IIO.0000000000000077 10.1097/IIO.0000000000000077]
+*Acute retinal necrosis. ''EyeWiki''. 2021. https://eyewiki.aao.org/Acute_retinal_necrosis
 [[Category:Ophthalmology]]