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Diagnosis and Treatment of Acute Retinal Necrosis: A Report by the American Academy of Ophthalmology.

Publication ,  Journal Article
Schoenberger, SD; Kim, SJ; Thorne, JE; Mruthyunjaya, P; Yeh, S; Bakri, SJ; Ehlers, JP
Published in: Ophthalmology
March 2017

PURPOSE: To evaluate the available evidence in peer-reviewed publications about the diagnosis and treatment of acute retinal necrosis (ARN). METHODS: Literature searches of the PubMed and Cochrane Library databases were last conducted on July 27, 2016. The searches identified 216 unique citations, and 49 articles of possible clinical relevance were reviewed in full text. Of these 49 articles, 27 were deemed sufficiently relevant or of interest, and they were rated according to strength of evidence. An additional 6 articles were identified from the reference lists of these articles and included. All 33 studies were retrospective. RESULTS: Polymerase chain reaction (PCR) testing of aqueous or vitreous humor was positive for herpes simplex virus (HSV) or varicella zoster virus (VZV) in 79% to 100% of cases of suspected ARN. Aqueous and vitreous specimens are both sensitive and specific. There is level II and III evidence supporting the use of intravenous and oral antiviral therapy for the treatment of ARN. Data suggest that equivalent plasma drug levels of acyclovir can be achieved after administration of oral valacyclovir or intravenous acyclovir. There is level II and III evidence suggesting that the combination of intravitreal foscarnet and systemic antiviral therapy may have greater therapeutic efficacy than systemic therapy alone. The effectiveness of prophylactic laser or early pars plana vitrectomy (PPV) in preventing retinal detachment (RD) remains unclear. CONCLUSIONS: Polymerase chain reaction testing of ocular fluid is useful in supporting a clinical diagnosis of ARN, but treatment should not be delayed while awaiting PCR results. Initial oral or intravenous antiviral therapy is effective in treating ARN. The adjunctive use of intravitreal foscarnet may be more effective than systemic therapy alone. The role of prophylactic laser retinopexy or early PPV is unknown at this time.

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Published In

Ophthalmology

DOI

EISSN

1549-4713

Publication Date

March 2017

Volume

124

Issue

3

Start / End Page

382 / 392

Location

United States

Related Subject Headings

  • Vitreous Body
  • Vitrectomy
  • Valine
  • Valacyclovir
  • United States
  • Simplexvirus
  • Retrospective Studies
  • Retinal Necrosis Syndrome, Acute
  • Polymerase Chain Reaction
  • Ophthalmology & Optometry
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Schoenberger, S. D., Kim, S. J., Thorne, J. E., Mruthyunjaya, P., Yeh, S., Bakri, S. J., & Ehlers, J. P. (2017). Diagnosis and Treatment of Acute Retinal Necrosis: A Report by the American Academy of Ophthalmology. Ophthalmology, 124(3), 382–392. https://doi.org/10.1016/j.ophtha.2016.11.007
Schoenberger, Scott D., Stephen J. Kim, Jennifer E. Thorne, Prithvi Mruthyunjaya, Steven Yeh, Sophie J. Bakri, and Justis P. Ehlers. “Diagnosis and Treatment of Acute Retinal Necrosis: A Report by the American Academy of Ophthalmology.Ophthalmology 124, no. 3 (March 2017): 382–92. https://doi.org/10.1016/j.ophtha.2016.11.007.
Schoenberger SD, Kim SJ, Thorne JE, Mruthyunjaya P, Yeh S, Bakri SJ, et al. Diagnosis and Treatment of Acute Retinal Necrosis: A Report by the American Academy of Ophthalmology. Ophthalmology. 2017 Mar;124(3):382–92.
Schoenberger, Scott D., et al. “Diagnosis and Treatment of Acute Retinal Necrosis: A Report by the American Academy of Ophthalmology.Ophthalmology, vol. 124, no. 3, Mar. 2017, pp. 382–92. Pubmed, doi:10.1016/j.ophtha.2016.11.007.
Schoenberger SD, Kim SJ, Thorne JE, Mruthyunjaya P, Yeh S, Bakri SJ, Ehlers JP. Diagnosis and Treatment of Acute Retinal Necrosis: A Report by the American Academy of Ophthalmology. Ophthalmology. 2017 Mar;124(3):382–392.
Journal cover image

Published In

Ophthalmology

DOI

EISSN

1549-4713

Publication Date

March 2017

Volume

124

Issue

3

Start / End Page

382 / 392

Location

United States

Related Subject Headings

  • Vitreous Body
  • Vitrectomy
  • Valine
  • Valacyclovir
  • United States
  • Simplexvirus
  • Retrospective Studies
  • Retinal Necrosis Syndrome, Acute
  • Polymerase Chain Reaction
  • Ophthalmology & Optometry