Acute Retinal Necrosis Follow-up

Updated: Feb 14, 2017
  • Author: Andrew A Dahl, MD, FACS; Chief Editor: C Stephen Foster, MD, FACS, FACR, FAAO, FARVO  more...
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Follow-up

Further Outpatient Care

Observe patients for reactivation or retinal detachment and for development of retinitis in the fellow eye.

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Further Inpatient Care

Check blood work.

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Inpatient & Outpatient Medications

Antivirals include acyclovir, valacyclovir, ganciclovir, famciclovir, and foscarnet.

An anti-inflammatory, such as prednisone, should be started 24-48 hours after antiviral therapy is initiated.

Antiplatelets (aspirin) should be started 24-48 hours after beginning antiviral therapy.

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Deterrence/Prevention

Prophylactic barrier laser to the peripheral retina posterior to the areas of retinal necrosis is required to reduce the risk of retinal detachment.

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Complications

Complications of acute retinal necrosis may include the following:

  • Retinal detachment (50%)
  • Anterior ischemic neuropathy
  • Cataract - From inflammation or steroids
  • Glaucoma - From inflammation or steroids
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Prognosis

Visual prognosis is guarded if retinal detachment, anterior ischemic optic neuropathy, or central retinal artery occlusion occur. [1, 2]

Fortunately, in the era of treatment with antivirals, acute retinal necrosis is usually a unilateral disease. The risk of involvement of the fellow eye was as high as 75% prior to the modern institution of therapy with acyclovir. Recent studies report fellow-eye involvement rates of 3-13% in patients presenting with unilateral disease and receiving prompt and extended treatment. [4, 20]

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