The acute retinal necrosis syndrome arns is a well established unilateral or bilateral condition of possibly herpetic origin in otherwise healthy patients 1,911,15,17,18 33,36,38,39,41. Acute retinal necrosis arn is a rare form of uveitis caused by a viral infection. Early detection and prompt treatment with acyclovir seems to improve the final visual outcome. Acute retinal necrosis arn is a rare infectious retinitis which can potentially lead to devastating visual outcomes. It was initially reported in 1971 by urayama et al in otherwise healthy young japanese adults. Valacyclovir as a therapeutic agent in acute retinal. Vavvasa,b,2 aretina service, angiogenesis laboratory, massachusetts eye and ear. Sir, acute retinal necrosis arn is a distinct ocular inflammatory syndrome whose prominent features include severe occlusive vasculitis, diffuse necrotizing retinitis. Necrose retiniana aguda e porn linkedin slideshare. Acute retinal necrosis arn is an infectious retinitis primarily caused by the herpesviruses.
Atypical acute retinal necrosis accompanied by tersons. It mostly occurs in adult patients, especially those severely. It is not clear whether the disease really is a new clinical entity or whether it. We report the case of a 41yearold man with clinical findings of viral meningitis associated with acute retinal necrosis syndrome in his right eye. A 34yearold male patient developed acute retinal necrosis in. In 1994, the executive committee of the american uveitis society.
It may affect the eye in many different ways, most often as conjunctivitis or uveitis. Acute retinal necrosis, cytomegalovirus retinitis, opportunistic infection, hiv. Epsteinbarr virus associated acute retinal necrosis. Editor,epsteinbarr virus ebv belongs to the group of herpesviruses. Acute retinal necrosis secondary to cytomegalovirus. Acute retinal necrosis arn is characterised by confluent, peripheral, necrotising retinitis, peripheral occlusive arteritis and moderatetosevere vitritis. Acute retinal necrosis after herpetic encephalitis ncbi. Receptor interacting protein kinases mediate retinal. It mostly occurs in adult patients, especially those severely immunocompromised, in association with a reactivation of a. The most common cause of acute retinal necrosis syndrome is the herpes zoster virus, although herpes simplex and cytomegalovirus have also been implicated. Arn is diagnosed on the basis of the clinical appearance and disease course according to the diagnostic criteria proposed by the american uveitis society. Akira urayama first described acute retinal necrosis syndrome arn in 1971 as consisting of acute unilateral panuveitis associated with retinal periarteritis and progressing to diffuse necrotizing retinitis and retinal detachment. Acute retinal necrosis arn is a rare infectious viral uveitis syndrome that manifests as a necrotizing retinitis and may result in a devastating visual outcome if not accurately diagnosed and treated.
Clinical diagnosis can be challenging and is often aided by pcrbased analysis of ocular fluids. Findings in a patient with herpes simplex viral meningitis. Acute retinal necrosis is a disease of young healthy individuals aged 2050 years. Receptor interacting protein kinases mediate retinal detachmentinduced photoreceptor necrosis and compensate for inhibition of apoptosis george trichonas a,b,1, yusuke murakami, aristomenis thanosa, yuki morizane a,b, maki kayama, christine m.
Pdf acute retinal necrosis arn is a serious condition that can impair vision. A bimodal age distribution possibly exists, peaking at approximately ages 20 and 50 years. Acute retinal necrosis arn is an ocular inflammatory condition characterized by peripheral necrotizing retinitis and is most often caused by varicella zoster virus vzv and herpes simplex virus hsv, though it may also be caused by cytomegalovirus cmv, progressive outer retinal necrosis porn, syphilis, toxoplasmosis, behcet disease, or. Relapse of acute retinal necrosis by cytomegalovirus. Acute retinal necrosis arn is seen in immunocompetent individuals, occurring after vzv and hsv infections. Optic nerve involvement in the acute retinal necrosis syndrome. Emerging concepts in the management of acute retinal necrosis. Acute lymphocytic leukemia masquerading as acute retinal. The disease has now been reported in children, patients with aids, and other immunocompromised patients.
Acute retinal necrosis arn is a syndrome characterized by progressive intraretinal inflammation and necrosis. Treatment of the acute retinal necrosis syndrome with intravenous acyclovir. This distribution may be related to differences in etiologic agents. The condition presents itself as a necrotizing retinitis. Necrosis retiniana externa progresiva porn slideshare. Holland gn 1994 standard diagnostic criteria for the acute retinal necrosis syndrome. We present six cases nine eyes seen in the medical eye unit of st thomass hospital over the past six years and discuss the clinical features, aetiology, and management. The impression of acute retinal necrosis was confirmed by polymerase chain reaction of aqueous humor by detecting herpes simplex virus type 2. Acute retinal necrosis arn is a rare syndrome with characteristic fundal appearances which can have devastating effects on vision. Response to antivegf therapy in macular oedema secondary. These are two separate entities with the differences summarized in table 1. The patient had multiple foci of retinitis in the retinal periphery associated with vitritis, blot retinal hemorrhage and retinal arteriolitis. Muthiah mn, michaelides m, child cs, mitchell sm 2007 acute retinal necrosis.
It presents with retinal vasculitis in some cases associated to optic neuritis, prominent vitreous and posterior pole inflammatory reaction, progressive peripheral. Atypical acute retinal necrosis accompanied by tersons syndrome. Acute retinal necrosis is a distinct ocular viral syndrome with a. Acute retinal necrosis arn is characterised by confluent, peripheral, necrotising retinitis, peripheral occlusive arteritis and moderate. Herpetic encephalitis is a risk factor for acute retinal.
The clinical diagnosis is frequently supported by the identification of the causative infectious agent, most commonly varicellazoster virus vzv, though herpes simplex virus hsv types 1 and 2, cytomegalovirus, and epsteinbarr virus ebv have also been implicated. Retinal laser photocoagulation was then applied to the border of the whiteyellow patched lesions to prevent the late consequence of retinal. Prophylactic laser photocoagulation and vitrectomy for. Acute retinal necrosis is a relatively newly described entity. Acute retinal necrosis is a viral syndrome characterized by a panuveitis with necrotizing retinitis that may be complicated by retinal detachment, vasoocclusion, optic neuropathy, and other causes of decreased visual acuity. For herpes simplex virus hsv and for varicella zoster virus vzv it is well known that they can cause acute retinal necrosis arn, but information regarding ebv retinitis is rare. Abstract acute retinal necrosis arn is a clinical syndrome characterized by vitritis, severe occlusive vasculitis which produces a full thickness, necrotizing retinitis. Immediate paracentesis was carried out to obtain an aqueous sample for polymerase chain reaction analysis. Acute retinal necrosis secondary to varicella zoster virus. Necrosis retinal aguda vs necrosis retinal externa progresiva.
We performed argon or krypton laser photocoagulation to demarcate areas of active retinitis as prophylaxis against retinal detachment in five patients. Acute retinal necrosis an overview sciencedirect topics. Based on these findings, acute retinal necrosis was suspected. Acute retinal necrosis arn has been observed in several cases after herpetic encephalitis he. Acute retinal necrosis arn syndrome is an infectious retinitis caused by members of the herpes virus family.
Advances in the management of acute retinal necrosis. Necrosis retinal aguda, necrosis retinal externa progresiva, retinopatia necrotizante herpetica. Mr images showed right optic nerve enlargement and highintensity signal abnormalities in the region of the left lateral geniculate body and the left occipital lobe. Therefore, early recognition and diagnosis are crucial.
Acute retinal necrosis arn, also known as kirisawatype uveitis, is an uncommon condition caused by infection of the retina by one of the herpes family of viruses, most typically varicella zoster virus or herpes simplex virus and less commonly cytomegalovirus. Acute retinal necrosis arn has characterized by panuveitis, vitritis, severe vasoocclusive vasculitis, and diffuse necrotizing retinitis. Necrosis retinal aguda vs necrosis retinal externa. It manifests as necrotizing retinitis that can result in devastating vision loss if not correctly diagnosed and treated. Retinal necrosis or necrotizing retinopathy can be acute or progressive and usually happens as a sequel of herpetic viral infections. Laser photocoagulation in the acute retinal necrosis. To study the association between arn and preceding neurologic illness, especially the cooccurrence of he in patients with arn. Atypical acute retinal necrosis arn responding to late. Anteriorsegment findings include episcleritis, scleritis, keratitis, andor anterior chamber inflammation, which may be either nongranulomatous or granulomatous. When varicellazoster virus or herpes simplex virus type 1 is involved, the median age is 57 and 47. Acute retinal necrosis syndrome following chickenpox. Acute retinal necrosis arn has been reported in aids patients. Acute retinal necrosis associated with epsteinbarr virus.
Arn is a devastating ocular disease with a very disappointing visual outcome. Acute retinal necrosis secondary to cytomegalovirus andrea p. Acute retinal necrosis arn is a serious condition that can impair vision. The inflammation onset is due to certain herpes viruses, varicella zoster virus vzv, herpes simplex virus hsv1 and hsv2 and epsteinbarr virus ebv people with the condition usually display redness of the eye, white or offwhite colored patches that. Acute retinal necrosis arn, is a medical inflammatory condition of the eye. The acute retinal necrosis arn syndrome is a highly aggressive infectious retinitis that can cause severe visual acuity reduction with bilateral presentation in one third of cases. Acute retinal necrosis arn is one of the clinical presentations of herpes simplex virus hsv.
876 1075 1520 1011 1585 1275 444 300 1151 934 1356 472 818 527 263 856 27 1251 1453 1468 1378 1493 1151 924 870 897 882 910 1341 350 325 746 1122 1183 934 1489