Clinical characteristics and outcomes of acute retinal necrosis at different stages: a retrospective study.

Abstract

Background: To examine the clinical features and treatment outcomes of patients with acute retinal necrosis (ARN) at different disease stages and identify the risk factors associated with a poor prognosis.

Methods: This retrospective study included 39 patients (44 eyes) with ARN who were treated at a single center. The eyes were divided into three stages based on the ocular findings and clinical course at the initial diagnosis. The main outcome measures were the incidence of retinal detachment (RD) and final visual acuity (VA). Regression analyses were performed to investigate the risk factors associated with the main outcomes.

Results: Nine, 10, and 25 eyes were in the early, middle, and late stages, respectively. Eyes in the early stage had the shortest symptom duration (P = 0.019). At the first visit, the intraocular pressure (IOP) was elevated in half the patients; 29 eyes (65.9%) had keratic precipitates (KPs) and five (11.6%) had iris nodules. The final VA improved in early-stage eyes (P = 0.008) and decreased in late-stage eyes (P = 0.004) after treatment. RD was not common with early diagnosis. Five (50%) and 17 (68%) eyes in the middle and late stages developed RD, respectively. Independent predictors of RD included the vitritis grade (P = 0.046) and clock hours of retinitis (P = 0.045). Initial VA at presentation (β = 0.291, P = 0.009), the occurrence of RD (β = 0.209, P = 0.033), and clock hours of retinitis (β = 0.323, P = 0.008) were identified as associated with final VA.

Conclusion: Early diagnosis and treatment are associated with positive clinical outcomes. Anterior segment signs (e.g., mildly or moderately elevated IOP, KPs, and iris nodules) are important for early diagnosis.