Transcript Case Report 44.46

ACUTE RETINAL NECROSIS
Nesrine Abroug
Rim Kahloun
Sonia Zaouali
Salim Ben Yahia
Department of Ophthalmology,
Fattouma Bourguiba University Hospital
Faculty of Medicine, University of Monastir,
Monastir, Tunisia
Ocular History
70-year-old male
 February 8, 2011 : vision blurring
OD

Ocular History
A
B
(A) Fundus photograph shows a focus of active retinitis
associated with retinal hemorrhages in the macular area
(arrow) and associated optic disc swelling
(B) Late-phase fluorescein angiogram shows blockage effect from
the area of active retinitis and dye leakage from retinal vessels
and the optic disc
Initial diagnosis
 Non-infectious
posterior uveitis
 Treatment with intravenous and
oral corticosteroids
A
B
February 21 th 2011 – First Presentation
 Referred to our department because of
worsening of visual complaints
 Visual acuity:
 OD: hand motion
 OS: 20/32
 Mild AC inflammatory reaction OD with
mutton-fat keratic precipitates and
endothelial folds
 Intraocular pressure : 10 mmHg OD
 1+ vitreous cells, 3+ vitreous haze OD
 OS : unremarkable
Slit-lamp photography shows granulomatous keratic precipitates
and endothelial folds
Color fundus photography showing 3+ vitreous haze, extensive
areas of necrotizing retinitis in the temporal and nasal periphery
(arrowheads) with diffuse narrowing of retinal vessels.
Work-up
 PCR on aqueous humor sample
identified Herpes Simplex virus-1
 Syphilis serology: negative
 PCR on aqueous humor sample
for toxoplasmosis: negative
Final diagnosis
Acute retinal necrosis
Treatment
 intravenous acyclovir followed by
oral antiviral therapy
 Oral prednisone was
administrated 3 days after
initiation of antiviral therapy
Follow-up
 Retinal detachment 3 weeks after initial
presentation
 phacoemulsification, pars plana
vitrectomy, endolaser photocoagulation,
and silicone oil tamponade
Retinal tear
Follow-up
 final visual acuity: 20/400,
 macular atrophy on OCT
 no retinitis developed in the fellow eye after
a follow-up period of 12 months
Conclusion
 In any patient with uveitis, an infectious cause
should be ruled out first
 Delayed diagnosis of ARN syndrome,
mistakenly treated with systemic
corticosteroids without coverage by antiviral
therapy, may lead to significant ocular
morbidity
 A careful clinical examination and aqueous
humor analysis for PCR viral antigen provide
clues for diagnosis of ARN syndrome and
identification of the causative agent