Background
Acute retinal necrosis (ARN) can lead to uveitis, retinal detachment, and blindness. Acute retinal necrosis was first described in the Japanese literature in 1971 and termed Kirisawa uveitis. During the past 3 decades, acute retinal necrosis syndrome has been a source of fear, frustration, and fascination for many ophthalmologists. Unfortunately, it usually is a visually devastating condition for the patient.
A necrotic retina is shown in the image below.
The white area is necrotic retina. Pathophysiology
Acute retinal necrosis may be a result of dormant herpes simplex virus 1 (HSV-1), herpes simplex virus 2 (HSV-2), or varicella-herpes zoster virus (VZV) viral reactivation in the retina. The exact etiology of this reactivation is still elusive; however, an immunogenetic predisposition to the disease is likely.
Epidemiology
Frequency
United States
Acute retinal necrosis accounts for 5.5% of uveitis cases over a 10-year period.[1]
International
In Switzerland, acute retinal necrosis accounts for 1.7% of uveitic cases.
Mortality/Morbidity
Significant visual loss may occur. Retinal detachment complicates most cases (~75%) and is a major cause of legal blindness in acute retinal necrosis.
Race
No clear racial predilection exists.
Sex
This condition appears to have a predilection for males; however, the extent is not clear.
Age
Acute retinal necrosis is a disease of young healthy individuals aged 20-50 years.
A bimodal age distribution possibly exists, peaking at approximately ages 20 and 50 years. This distribution may be related to differences in etiologic agents. When varicella-zoster virus or herpes simplex virus type 1 is involved, the median age is 57 and 47 years, respectively. When herpes simplex virus type 2 is involved, the median age is 20 years.
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