Acute retinal necrosis: Difference between revisions
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*Directed by causative organism |
*Directed by causative organism |
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*Involvement of Ophthalmology |
*Involvement of Ophthalmology |
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| − | *Typically requires intravenous ± intravitreal [[Is treated by::acyclovir]], stepped down to oral [[valacyclovir]] after |
+ | *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 |
**Sometimes intravitreal [[ganciclovir]] or [[foscarnet]] is added |
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*May require steroids, usually added after 24 hours of antiviral therapy |
*May require steroids, usually added after 24 hours of antiviral therapy |
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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
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
Further Reading
- Advances in the Management of Acute Retinal Necrosis. Int Ophthalmol Clin. 2015;55(3):1–13. doi: 10.1097/IIO.0000000000000077
- Acute retinal necrosis. EyeWiki. 2021. https://eyewiki.aao.org/Acute_retinal_necrosis
