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.