Acute Retinal Necrosis Presenting with Exudative Retinal Detachment: Clinical Features and Outcomes.

PURPOSE: To analyze the clinical characteristics and outcomes of patients presenting with an exudative retinal detachment (ERD) in Acute Retinal Necrosis (ARN).

METHODS: Retrospective, observational review of cases of ARN with exudative retinal detachment (ERD) that presented to tertiary eye care institutes in Southern and Eastern India between 2015 and 2024.

RESULTS: Clinical records of 322 cases of ARN were reviewed. ERD was noted in 21 eyes of 14 patients (4.34%). ARN involved all the four quadrants in 18 eyes (90%) and three quadrants in 2 eyes (10%). Seven patients had bilateral ARN at the time of initial presentation. Presenting clinical features included occlusive vasculitis in 18 eyes (90%), marked vitritis in 7 eyes (35%), disc edema in 5 eyes (25%). Initial therapy included intravenous (IV) acyclovir in 12 patients (92.3%), IV methylprednisolone in 8 patients (61.5%), and intravitreal ganciclovir in 9 eyes (45%). All the patients were also treated with oral steroids and concomitant systemic antivirals. ERD was seen to resolve in all patients in mean duration of 11.45 ± 4.78 days. 10 eyes (50%) subsequently also developed a rhegmatogenous retinal detachment (RRD). Optic atrophy was seen in 5 eyes (25%), and hypotony in 4 eyes (20%).

CONCLUSION: ERDs, while rare, are important findings in patients with ARN and are a sign of extensive disease activity and extreme inflammation. Eyes with ERD have a higher incidence of occlusive vasculitis and more severe quadrantic involvement.