Clinicians describe case of acute retinal necrosis

German clinicians have described their treatment of a patient in his 60s with acute retinal necrosis.

Writing in BMJ Case Reports, the authors shared that the man presented to the Augenklinik Ahaus eye care clinic reporting a significant decline in visual acuity as well as floaters that had persisted for the past two days in his right eye.

The patient had type 2 diabetes, medically managed hypertension and a myocardial infarction six years previously.

A month previously, the patient had experienced a herpes zoster infection on his back.

Further examination by the clinicians revealed a best corrected visual acuity of 6/12 in his right eye and 6/6 in his left eye. He had elevated intraocular pressure (38 mm Hg) in his right eye, while pressure remained within normal levels in his left eye.

Fundus images obtained using the Optomap ultra-widefield (UWF) imaging system revealed multiple, focal, white-to-yellow lesions throughout the peripheral retina. There was no evidence of retinal detachment and the posterior pole appeared normal.

Working with a diagnosis of panuveitis, the patient was given oral acetazolamide and topical dorzolamide to lower his IOP in the affected eye.

A dilated fundus examination confirmed that the lesions extended to the retinal periphery. The patient was referred to a specialised university eye hospital, where he was admitted and given intravenous anti-viral therapy.

The clinicians highlighted that the clinical findings met the clinical criteria established by the American Uveitis Society for a diagnosis of acute retinal necrosis (ARN).

The patient received intravenous acyclovir treatment, with treatment switched to oral acyclovir following signs of improvement in the panuveitis by day 12.

At a follow up appointment four months after discharge, the patient reported no symptoms. The best corrected visual acuity in the right eye improved to 6/7.5.