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Prognostic factors associated with acute retinal necrosis treated non-surgically

Eye (2024)Cite this article

Subjects

Abstract

Objectives

To analyse the prognostic factors for visual acuity in acute retinal necrosis (ARN) patients treated non-surgically.

Methods

The clinical data of ARN patients who visited our hospital from January 2010 to January 2023 were retrospectively analysed.

Results

Twenty-four patients (29 eyes) were included. Aqueous humour samples were collected from 20 out of 29 eyes, and PCR confirmed that 85% (17/20) of the eyes had VZV infection, 10% (2/20) had CMV infection, and 5% (1/20) had HSV infection. All patients were treated with intravenous antiviral agents. Intravitreal ganciclovir and oral corticosteroids were given according to the patients’ wishes. A comparison of visual acuity at the time of first identification of inactive ARN with that at the first visit revealed that 16 (55.2%) eyes improved and 13 (44.8%) did not improve. Logistic regression analysis revealed that risk factors for failure to improve vision after treatment included retinal detachment (odds ratio [OR],33.75; 95% CI, 3.245–351.067; P = 0.003), necrotising retinitis involving the posterior pole (odds ratio [OR],8.167; 95% CI, 1.297–51.403, P = 0.025), and arteritis involving the large retinal arteries (odds ratio [OR],9.167; 95% CI, 1.493–56.297; P = 0.017). The VZV viral load in the aqueous humour at initial presentation was significantly associated with visual prognosis (r = 0.688, P = 0.013), retinal detachment (τ = 0.597, P = 0.021) and the extent of retinal necrosis (τ = 0.57, P = 0.027). The neutrophil to lymphocyte ratio (NLR) of VZV-infected patients at first presentation was significantly correlated with the prognosis of visual acuity (r = 0.616, P = 0.033) and retinal detachment (τ = 0.728, P = 0.004).

Conclusions

High NLR and viral DNA copy number in the aqueous humour at the initial presentation, as well as subsequent retinal detachment, necrotising retinitis involving the posterior pole, and arteritis involving the large retinal arteries were risk factors for poor visual prognosis in VZV-infected ARN patients.

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Fig. 1: Schematic diagram of retinal necrotic areas.
Fig. 2: Factors influencing visual prognosis.
Fig. 3: Correlation between VZV viral load, NLR and visual prognosis and retinal detachment.

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Data availability

The original contributions presented in the study are included in the article material, further inquiries can be directed to the corresponding author.

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Acknowledgements

This work was supported by National Natural Science Foundation of China (82371043), and the Project of Outstanding Talents in Scientific and Technological Innovation and Entrepreneurship for Middle-aged and Young Scientists of Jilin Provincial Science and Technology Department (20240601014R).

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Authors and Affiliations

  1. Ophthalmologic Center of the Second Hospital, Jilin University, Changchun, PR China

    Haihui Wei, WenJing Xu, Hai Jiang, Siyan Jin & Xiaoli Liu

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  1. Haihui Wei
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Contributions

HW analysed data, wrote and revised manuscript. WX analysed the data and provided comments for discussion part. HJ collected specimens. SJ collected specimens and analysed the data. XL is guarantor, designed this research and participated in the interpretation and discussion of the results, revised manuscripts, submitted manuscripts and applied for funding.

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Correspondence to Xiaoli Liu.

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Wei, H., Xu, W., Jiang, H. et al. Prognostic factors associated with acute retinal necrosis treated non-surgically. Eye (2024). https://doi.org/10.1038/s41433-024-03319-3

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