• Ahmad M Sidiqi, Mahadev Bhalla, Haaris M Khan, Forson Chan, Christopher Lowe, and Eduardo V Navajas.
• Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, ON, Canada.
• Ir J Med Sci. 2024 Feb 1; 193 (1): 509516509-516.

BackgroundAcute retinal necrosis (ARN) is a progressive necrotizing retinitis caused by viral infection. Optimal management strategies have not been established for this detrimental disease. Previous literature published suggests that Varicella-zoster virus (VZV) and Herpes simplex virus-1 (HSV1) are the most common promoters of acute retinal necrosis (ARN).AimsThe purpose of our study was to investigate the viral distribution, demographic, and treatment outcomes of ARN.MethodsA retrospective chart review evaluated data from PCR-positive ARN patients diagnosed between 2009 and 2018.ResultsAnalysis of fourteen eyes from 12 patients found CMV and VZV as the commonest causes of ARN. Patients on 1 g of valacyclovir three times a day (V1T) had worse vision between first and final visits (mean difference of 1.25 ± 0.65, n = 2) compared with patients treated with 2 g of valacyclovir three times a day (V2T), or 900 mg twice a day of valganciclovir (V9B) (mean difference of - 0.067 ± 0.13, n = 6, and 0.067 ± 0.067, n = 6, respectively). Both V1T patients developed retinal detachments (RD). Both CMV patients treated with intravitreal triamcinolone developed ARN, elevated IOP, and one developed multiple RD.ConclusionsOur review found increased incidence of CMV-positive ARN. Patients with zone 1 disease had worse initial visual acuity. Moreover, patients had more favorable outcomes with V2T and V9B compared to V1T. CMV-positive patients clinically worsened after intravitreal steroid injections, further underscoring the value of a PCR diagnosis to tailor the patients' treatment plan accordingly.© 2023. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.

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