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Park, Shin, Byon, Park, Lee, and Oum: Risk Factors of Retinal Detachment after Acute Retinal Necrosis
Original Article

J Korean Ophthalmol Soc 2013;54(11):1694-1699.

Published online: 2 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.11.1694

Risk Factors of Retinal Detachment after Acute Retinal Necrosis

Sung Who Park, MD1, Min Kyu Shin, MD1, Ik Soo Byon, MD2, Huyun Jun Park, MD, PhD3, Ji Eun Lee, MD, PhD1, Boo Sup Oum, MD, PhD4

1Department of Ophthalmology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea

2Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea

3Choi Eye Clinic, Gimhae, Korea

4Jung Geun Eye Hospital, Busan, Korea

Address reprint requests to Ji Eun Lee, MD, PhD, Department of Ophthalmology, Pusan National University Hospital, #179 Gudeok-ro, Seo-gu, Busan 602-739, Korea, Tel: 82-51-240-7957, Fax: 82-51-242-7341, E-mail: jlee@pusan.ac.kr

Received 12 April 2013       Revised 29 May 2013       Accepted 23 September 2013

Copyright © 2013 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Retinal detachment (RD) complicated in acute retinal necrosis (ARN) is difficult to be treated and a main cause of blindness. The factors associated with RD in ARN were investigated.

Methods

Patients with ARN who were diagnosed and treated from Jan, 2008 to Dec, 2012 were reviewed retrospectively. The eyes were classified into the group I without RD, and the group II with RD. Early vitrectomy, history of ARN in the other eye, extent of necrosis, symptom duration and intravitreal injection of anti-viral drug were evaluated.

Results

Of 22 eyes of 20 patients, 11 eyes were included in each group. Symptom duration of 8.0 days in the group I was shorter than 15.8 days in the group II (p = 0.005). There were no macular involvement at initial exam in the group I and 5 eyes (45%) in the group II (p = 0.017). Five eyes (45%) in the group I and 0 eye (0%) in the group II had history of ARN in the other eye (p = 0.017). Six eyes (55%) in the group I and 1 eye (9%) in the group II underwent early vitrectomy (p = 0.031). Age, baseline visual acuity, and intravitreal injection of antiviral agent were not related to RD (p = 0.294-0.699).

Conclusions

Broader necrosis and longer symptoms duration were related to occurrence of RD. Correlation of Lower risk of RD with ARN history in the other eye would result from earlier diagnosis and treatment. Early vitrectomy seems to be effective to prevent RD in ARN.

Keywords: Acute retinal necrosis, Early vitrectomy, Retinal detachment

References

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Figure 1.
Group I, patient 5. (A) Two days after systemic antiviral and laser treatment, fundus photo shows that retinal necrosis did not extend to the macula. Pigmented laser scar (black arrow) by previous treatment several years ago is noted. (B) Five months after early vitrectomy, there is no retinal detachment, vitreous inflammation, or retinal necrosis.
jkos-54-1694f1.tif
Figure 2.
Group II, patient 12. (A) Two days after systemic antiviral and laser treatment, fundus photo shows that the macula was involved by retinal necrosis. (B) Ten days after early vitrectomy, vitreous cavity was filled with silicone oil and the retina is attached without necrotic lesion. (C) Fifty days after early vitrectomy, although it is filled with the tamponade, subretinal fluid is note. (D) Optical coherence tomography demonstrates presence of subretinal fluid.
jkos-54-1694f2.tif
Table 1.
Demographic characteristics of the patients
Group I Group II p-value
Age 52.2 57.5 0.365
Sex (male:female) 7:5 5:7 0.342
Symptoms duration (days) 8.0 15.8 0.013
Initial visual acuity (log MAR) 0.64 0.55 0.652
Extend of necrosis 0.005
 Zone I (%) 0 (0) 5 (45) 0.017
 Zone II (%) 8 (73) 6 (55) 0.236
 Zone III (%) 3 (27) 0 (0) 0.107
History of ARN in another eye (%) 5 (45) 0 (0) 0.017
Early vitrectomy (%) 6 (55) 1 (9) 0.031
Intravitreal injection (%) 3 (27) 1 (9) 0.293
Final visual acuity (log MAR) 0.37 1.55 0.001
Table 2.
Patient data
Number of cases Group Extend of necrosis Symptoms duration (days) Past history of ARN Early vitrectomy Intravitreal injection Proliferative vitroretinopathy Final visual acuity
1 I 2 1 + + − − 20/50
2 II 2 21 − − − + 20/40
3 I 2 20 − + − − 20/100
4 II 1 30 − − − + NLP
5 II 1 21 − − − + NLP
6 I 3 1 + − − − 20/30
7 I 3 7 + − − − 20/20
8 II 2 9 − − − + HM
9 I 2 15 − − − − 20/25
10 I 2 7 − − + − 20/50
11 II 1 10 − − − + H.M
12 II 2 15 − − − + 2/100
13 II 1 14 − − − + L.P
14 I 2 7 + + + − 10/160
15 II 1 20 − + + + F.C
16 I 3 1 − + − − 20/20
17 I 2 5 + − − − 20/40
18 II 2 14 − − − + 4/100
19 I 2 10 − + + − 20/40
20 II 2 15 − − − + 20/125
21 II 2 5 − − + 4/100
22 I 2 14 − + − − 20/100
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