Our Summary

Acute retinal necrosis, or ARN, is an eye disease caused by viral infection. While there is no ideal treatment yet, two viruses - the Varicella-zoster virus (VZV) and Herpes simplex virus-1 (HSV1) - are often associated with this disease.

This study looked back at the medical records of ARN patients diagnosed over a decade (2009-2018). They found that two other viruses - CMV and VZV - were the most common causes of ARN.

Patients who took 1 gram of the antiviral drug valacyclovir three times a day had worse vision over time, compared to patients who took higher doses of the same drug, or another drug called valganciclovir. Also, both patients taking the lower dose of valacyclovir ended up with retinal detachments.

Patients with CMV who were treated with a steroid injection in the eye got worse, some developing high eye pressure and retinal detachments. This suggests that knowing which virus is causing the ARN can help doctors decide the best treatment for each patient.

To summarize, CMV is a common cause of ARN, and patients with a more severe form of the disease had worse initial eyesight. Higher doses of antiviral drugs were more effective, and steroid injections can make CMV patients worse.

FAQs

  1. What are the most common viruses associated with Acute Retinal Necrosis (ARN)?
  2. How does the dosage of the antiviral drug valacyclovir affect the progression of ARN?
  3. Can steroid injections improve the condition of ARN patients with a CMV infection?

Doctor’s Tip

Therefore, it is important for patients undergoing retinal surgery to discuss with their doctor the specific virus causing their ARN and the appropriate treatment plan for their individual case. It is crucial to follow the recommended medication regimen and attend follow-up appointments to monitor progress and prevent complications. Additionally, maintaining overall eye health through regular eye exams and healthy lifestyle habits can support the success of retinal surgery.

Suitable For

Overall, patients with acute retinal necrosis who have severe vision loss or complications such as retinal detachment may be recommended for retinal surgery. Additionally, patients with ARN caused by CMV may require more aggressive treatment strategies, such as higher doses of antiviral drugs, to improve outcomes. It is important for doctors to determine the specific virus causing ARN in order to tailor the treatment plan to each individual patient.

Timeline

Before retinal surgery:

  1. Patient experiences symptoms of acute retinal necrosis (ARN), such as floaters, blurry vision, eye pain, and sensitivity to light.
  2. Patient is diagnosed with ARN through a comprehensive eye examination and possibly a viral testing to determine the specific virus causing the disease.
  3. Treatment plan is determined based on the viral cause of ARN, which may include antiviral drugs like valacyclovir or valganciclovir, and possibly steroid injections.
  4. Patient undergoes treatment to manage the symptoms and prevent further damage to the retina.

After retinal surgery:

  1. Patients who took lower doses of antiviral drugs like valacyclovir may experience worse vision over time and may develop retinal detachments.
  2. Patients with CMV who received steroid injections in the eye may experience complications such as high eye pressure and retinal detachments.
  3. Knowing the specific virus causing ARN can help doctors tailor the treatment plan for each patient to achieve better outcomes.
  4. Regular follow-up appointments are needed to monitor the patient’s progress and adjust the treatment plan as needed.

What to Ask Your Doctor

Some questions a patient should ask their doctor about retinal surgery for ARN may include:

  1. What specific virus is causing my ARN and how does that impact my treatment options?
  2. What are the potential risks and benefits of different antiviral drugs for treating ARN?
  3. Is there a preferred dosage or type of antiviral medication that has been shown to be more effective in treating ARN?
  4. Are there alternative treatments to steroid injections for managing ARN, especially for patients with CMV?
  5. How often will I need to follow up with my doctor after retinal surgery for ARN, and what should I expect in terms of recovery and potential complications?
  6. Are there any lifestyle changes or precautions I should take to help prevent recurrence of ARN or other complications after surgery?
  7. What are the long-term implications of ARN on my vision and overall eye health, and how can I best manage these?

Reference

Authors: Sidiqi AM, Bhalla M, Khan HM, Chan F, Lowe C, Navajas EV. Journal: Ir J Med Sci. 2024 Feb;193(1):509-516. doi: 10.1007/s11845-023-03426-2. Epub 2023 Jun 27. PMID: 37365446