Acute Retinal Necrosis: Case Report

Abstract

30-year-old woman was admitted with complaints of decreased vision and pain in the left eye for the previous seven days. Visual acuity was 1.0 on the right eye and 0,2 on the left eye. Ophthalmologic examination of the left eye revealed conjunctival hyperemia, 3+ cellular reaction in the anterior chamber, diffuse keratic precipitates, 2 + cellular reaction in the vitreous. In fundoscopic examination, multiple retinal hemorrhages and foci of retinal necrosis were detected in peripheral retina with arteriolitis. The examination of the right eye was normal. The patient was admitted with the diagnosis of acute retinal necrosis and received intravenous acyclovir for ten days (10 mg/kg/day). After 48 h of antiviral therapy, systemic corticosteroid therapy (prednisolone 1 mg/kg/day) was introduced and tapered over eight weeks. Prophylactic barrier laser photocoagulation was performed in the areas of retina at the posterior borders of the necrotic lesion. During follow-up, the inflammation decreased and the patient did not have retinal detachment or other eye involvement. Acute retinal necrosis (ARN) is a syndrome with severe loss of vision and its diagnosis mostly depends on clinical appearance. ARN can be taken under control by the correct diagnosis and effective treatment. Visual prognosis can be better after the treatment and the involvement of the other eye can be prevented. Key words: Acute Retinal Necrosis; Acyclovir; Prognosis.

Keywords

• Acute Retinal Necrosis; Acyclovir; Prognosis.

Akut Retinal Nekroz: Olgu Sunumu

Öz

Otuz yaşında kadın hasta, yedi günden beri süregelen, sol gözde görme azalması ve ağrı şikayeti ile kliniğimize başvurdu. Yapılan oftalmolojik muayenede snellen eşeline göre sağ gözde görme düzeyi 1,0 iken sol gözde 0,2 idi. Sol gözde konjonktival hiperemi, ön kamarada 3+ hücre, diffüz keratik presipitatlar ve vitreusta 2+ hücre saptandı. Sol göz fundus muayenesinde arteriolitle birlikte retina periferinde multipl retinal hemoraji ve nekroz alanları mevcuttu. Sağ göz ön ve arka segment muayene bulguları normaldi. Klinik bulgulara göre ARN düşünülerek on günlük intravenöz asiklovir (10 mg/kg) tedavisi uygulandı. Antiviral tedaviden 48 saat sonra sistemik kortikosteroid (1 mg/kg/gün) verildi ve yaklaşık sekiz hafta içinde azaltılarak kesildi. Nekroz alanının arka sınırına profilaktik argon lazer fotokoagülasyon yapıldı. Takip süresince inflamasyon bulguları azaldı, retina dekolmanı ve bilateral tutulum gözlenmedi. Akut retinal nekroz; ciddi görme kaybına neden olabilen bir durum olup, tanısı büyük ölçüde klinik görünüme dayanmaktadır. Doğru tanı ve tedavi yaklaşımı ile akut retinal nekroz kontrol altına alınabilir, görme prognozu üzerindeki olumsuz etkisi azaltılabilir ve diğer gözün tutulumu önlenebilir. Anahtar kelimeler: Akut Retinal Nekroz; Asiklovir; Prognoz.

Anahtar Kelimeler

• Akut Retinal Nekroz; Asiklovir; Prognoz.

Kaynakça

1. Rabinovitch T, Nuzik RA, Varenhorst MP. Bilateral
2. acute retinal necrosis. Am J Ophthalmol 1989;108: 735- 6.
3. Pepose JS, Flowers B, Stewart JA, Grose C, Levy GS, Culbertson WW, et al. Herpes virus antibody levels in the etiologic diagnosis of acute retinal necrosis syndrome. Am J Ophthalmol 1992;113:248-56.
4. Fox GM, Crouse CA, Chuang EL, Pflugfelder SC, Cleary TJ, Nelson SJ, et al. Detection of herpesvirus DNA in vitreous and aqueous specimens by the polymerase chain reaction. Arch Ophthalmol 1991; 109:266-71.
5. Holland GH and Executive Committee of the American Uveitis Society. Standart diagnostic criteria for the acute retinal necrosis syndrome. Am J Ophthalmol 1994;117:663-6.
6. Palay DA, Sternberg P Jr, Davis J,Lewis H, Holland GN, Mieler WF et al. Decrease in the risk of bilateral acute retinal necrosis by acyclovir therapy. Am J Ophthalmol 1991;112:250-5.
7. Hung SO, Patterson A, Rees PJ. Pharmocokinetics of oral acyclovir in the eye. Br J Ophthalmol 1984;68:192- 5.
8. Süllü Y, Oge I, Erkan D, Aritürk N, Mohajeri F. Cyclosporin-A therapy in severe uveitis of Behcet's disease. Acta Ophthalmol Scand 1998;76:96‒9.