Clinical profile and treatment outcomes in acute retinal necrosis in a South Indian patient population

Purpose: To look at the clinical profile, treatment methods, and outcomes in cases of acute retinal necrosis (ARN) from a tertiary eye care center. Methods: Hospital-based retrospective observational study wherein cases of ARN presented between January 2016 and December 2023 were reviewed. Demographic details, clinical presentation, complications, management, and visual outcome were evaluated. Results: Twenty eyes of 18 cases were included in the study. Mean age was 40.77 ± 16.38 years, male to female ratio was 2:1, and 11.11% had bilaterality at presentation. Mean duration of uveitis was 3.312 ± 0.95 months. The most commonly found organism was VZV (50%), followed by HSV (45%). All cases were given intravitreal ganciclovir in addition to systemic antivirals and oral steroids. The mean number of intravitreal injections was 5.53 ± 3.87. Maintenance dose of oral valacyclovir (500 mg twice daily) was continued in all cases for an average duration of 5.61 ± 3.79 months. The most common complications noted were retinal detachment (50%) followed by optic atrophy (44.44%). No significant association was noted between the extent of retinitis and the development of complications (P = 0.215). However, there was a significant difference seen in the rate of complications between the HSV and VZV groups, with more complication rates seen with the VZV group (P = 0.04). The mean visual acuity was 0.87 ± 0.85 logMAR at presentation and 0.65 ± 0.67 logMAR at the end of the study. Conclusion: Timely diagnosis, aggressive initial treatment with intravitreal ganciclovir along with systemic antivirals and long-term maintenance therapy with systemic antivirals are crucial in ARN to obtain the best visual prognosis achievable and prevent lifelong disabilities.