Table 4.
Demographics and clinical characteristics of Acute Retinal Necrosis
| Author (year) |
Age (years) |
Gender, n (%) |
Laterality, n (%) |
Immun odeficiency, n (%) |
Viral etiology, n (%) |
Method of diagnosis |
Previous herpes infection, n (%) |
Symptoms, n (%) |
Signs, n (%) | VA at presentation |
Treatment, n (%) |
Complications, n (%) |
Duration of follow- up (months) |
VA at last visit |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Tran et al (2004)240 | Mean: 36; range: 10–57 | M: 6; F: 5 | B: 4 (27.2); U: 7 | 0 | HSV-2: 11 | Aqueous or vitreous biopsy | Neonatal herpes: 1; previous ARN: 3 | NR | RPE abnormalities, neuroretinal atrophy, chorioretinal scars | Range: 20/25–CF; <20/60: 4; 20/70–20/400: 4; >20/400: 4 | IV acyclovir/foscarnet, intravitreal ganciclovir, oral valacyclovir, interferon, vitrectomy, laser | RD: 5 (41.7); ERM: 4 (33.3); cataract: 5 (41.7); optic nerve atrophy: 2 (16.7); CME: 1 (8.3) | Mean: 14.5; range: 5–22 | Improved: 5 (41.7); <20/60: 4 (33.3); 20/70–20/400: 4 (33.3); >20/400: 4 (33.3) |
| Lau et al (2006)146 | Mean: 49.5±3.5; median: 51; range: 18–83 | M: 10; F: 12 | B: 5 (22.7); U: 17 | 0 | VZV alone: 9/18 (50.0); HSV alone: 4/18 (22.2); EBV + VZV: 3/18 (16.7) | Vitreous biopsy | Shingles: 2; cold sore: 1; Ramsay Hunt syndrome: 1; corneal dendritic ulcer: 1 | Flu-like symptoms: 1 (4.5) | NR | Mean: 0.32 ± 0.05 | Systemic corticosteroid, laser, IV and oral acyclovir, vitrectomy | RD: 14/27 (51.9); macular lesion: 7 (25.9); vitreoretinopathy: 7 (25.9); optic neuropathy: 3 (11.1); ERM: 1 (3.7); cataracts: 1 (3.7); glaucoma: 1 (3.7) | Mean: 48; range: 12–146 | Mean: 0.38 ± 0.17 |
| Muthiah et al (2007)179 | Mean: 54.3; range: 13–85 | M: 22 (71.0); F: 9 (29.0) | B: 3 (9.7); U: 28 (90.3) | 7 (22.6) | VZV: 9; HSV-1: 3; HSV-2: 2; HSV-1 + HSV-2: 1; HSV + VZV: 1 | Aqueous or vitreous biopsy | Herpes simplex keratitis: (9.7); herpes zoster ophthalmicus: (20.7); cold sore: (25.0); genital ulcers: (4.5); encephalitis: (15.4); chicken pox: (70.6); Shingles: (29.4) | Sudden visual loss: (85.1); photophobia: (54.5); flu-like symptoms: (26.1); ocular pain: (25.8); red eye: (16.1) | AC activity: 25 (80.6); vitreous cells: 26 (83.9); peripheral retinal involvement: 25 (80.6) | Range: 6/5–NPL | IV antivirals (acyclovir, ganciclovir, and cidofovir): 23 (85.2); oral antivirals (acyclovir and valacyclovir): 4 (14.8); systemic steroids: 16 (51.6); aspirin: 2 (6.5); laser: 5 | RD: 9/12 (75.0); hypotony, CME, rubeosis | 12 | Worsened: 15/34 (44.1); improved: 9/34 (26.5) |
| Hillenkamp et al (2009)90 | Mean: 58 ± 21; range: 17–96 | M: 16; F: 11 | B: 3; U: 24 | NR | VZV alone: 23; HSV alone: 4; VZV + EBV: 2; VZV + HSV:1 | Vitreous biopsy | NR | NR | NR | Mean: 1.09 ± 0.83; range: 0.1–3.0 | IV acyclovir + oral prednisolone: 32; vitrectomy, intravitreal acyclovir, laser: 10 | RD: 22/30 (73.0); phthisis: 2/30 | Mean: 38 ± 53; range: 1–216 | Mean: 1.46 ± 0.88; range: 0.18–3.0 |
| Meghpara et al (2010)172 | Mean: 42 ± 19; range: 9–77 | M: 5; F: 15 | B: 5 (25.0); U: 15 (75.0) | 0 | VZV: 2; CMV: 1 | Vitreous biopsy | Chicken pox: 7 (35.0); cold sore: 5; shingles: 2; genital ulcers: 1; pharyngeal herpes: 1 | NR | Retinal involvement: <25%: 11 (44.0), 25–50%: 8 (32.0), >50%: 6 (24.0); optic disk swelling: 6 | NR | IV acyclovir/foscarnet: 14 (70.0); oral acyclovir/valacyclovir/famciclovir: 19 (95.0); intravitreal ganciclovir/foscarnet: 11 ganciclovir implants: 2 (8.0%); laser: 6 (24.0) (44.0); | RD: 5 (25.0) | Mean: 20.4 ± 20.5; range: 0.3–57.9 | Improved: 4; worsened: 5 |
| Cochrane et al (2012)42 | Range: 10–94 | M: 25 (55.6); F: 20 (44.4) | B: 7 (15.6); U: 38 (84.4) | 13 (28.9) | VZV alone: 15; HSV alone: 9; CMV alone: 2; EBV alone: 1; VZV+EBV: 2; VZV+CMV: 1 | Aqueous tap, vitreous biopsy, or CSF lumbar puncture | Chicken pox: 9 (20.2); Shingles/herpes zoster ophthalmicus: 6 (13.3); encephalitis/meningitis: 7 (15.6) | NR | NR | NR | Oral antivirals: 11 (24.4; 8 with valacyclovir); IV antivirals: 34; intravitreal antivirals (foscarnet): 21 (46.7); oral steroids: 26 (57.8); aspirin: 14/43 (32.6); laser: 10 (23.2) | RD: 16/52 (30.8); phthisis: 2/42 (4.7) | 6 | <6/60: 21 (47.7) |
| Roy et al (2014)205 | Mean: 36.0; range: 6–70 | M: 38 (71.7); F: 15 (28.3) | B: 9 (17.0); U: 44 (83.0) | 2 | VZV: 28 (45.2); HSV: 19 (30.6) | Aqueous or vitreous biopsy | Chicken pox: 4 (7.5); herpes encephalitis: 1 | Hazy vision: 53 (100.0); headache/periocular pain: 10 (18.9); viral fever: 4 (7.5) | Retinal necrosis | Mean: 2.02 | Oral steroids, systemic acyclovir, laser, vitreoretinal surgery | RD: 41 (66.1); proliferative vitreoretinopathy: 14 (35.0); optic atrophy: 10 (29.4); phthisis: 4 (11.7); hypotony: 3 (8.8); macular scar: 1 (2.9) | Mean: 27; range: 6–120 | Mean: 1.78; <6/60: 28 (45.1) |
| Summary; n, % | Mean: 46.0; range: 6–96 | M: 122 (58.4); F: 87 (41.6) | B: 36 (17.2); U: 173 (82.8) | 22 (12.1) | VZV alone: 86 (41.1); HSV alone: 53 (25.4); CMV: 4 (1.9); EBV: 8 (3.8) | Aqueous or vitreous biopsy, CSF | Chicken pox: 42 (20.1); shingles: 19 (9.1); cold sore: 14 (6.7); herpes encephalitis: 13 (6.2); others: neonatal herpes, herpes simplex keratitis, genital ulcers | Vision loss, ocular pain, photophobia, flu-like symptoms, red eye | AC inflammation; retinal necrosis, RPE abnormality, neuroretinal atrophy, chorioretinal scars | Range: 6/5-NPL | Systemic/intravitreal antivirals, systemic/topic steroids, aspirin, prophylactic laser, vitrectomy | RD: 112 (53.6); phthisis: 8 (3.8); macular lesion: 13 (6.2); optic neuropathy/atrophy: 15 (7.2); cataracts:6 (2.9); others: CME, rubeosis, vitreoretinopathy | Mean: 23.7; range: 0.3–216 | Majority worsen or no improvement |
AC, anterior chamber; ARN, acute retinal necrosis; B, bilateral; CME, cystoid macular edema; CF, counting fingers; CSF, cerebrospinal fluid; EBV, Epstein-Barr virus; ERM, epiretinal membrane; F, female; HM, hand movement; HSV, herpes simplex virus; IV, intravenous; M, male; NR, not reported; NPL, no light perception; PCR, polymerase chain reaction; PL, light perception; RD, retinal detachment; U, unilateral; VA, visual acuity; VZV, varicella zoster virus.