Acute retinal necrosis neuropathy. Clinical profile and surgical therapy
R. C. Sergott, R. Anand, J. B. Belmont, D. H. Fischer, T. M. Bosley and P. J. Savino
Neuro-ophthalmology Service, Wills Eye Hospital, Philadelphia, Pa 19107.
Twelve patients (17 eyes) with the acute retinal necrosis syndrome were
analyzed with special reference to the development of an acute optic
neuropathy. Six patients (9 eyes) without acute optic nerve involvement
were treated with intravenous acyclovir sodium and/or vitreoretinal surgery
(group 1). Six patients (8 eyes) fulfilling absolute and relative criteria
for acute retinal necrosis optic neuropathy were treated with intravenous
acyclovir as well as optic nerve sheath decompression, and, in addition,
some of these patients also underwent vitreoretinal surgery. Despite more
pronounced initial visual loss compared with group 1, six eyes in group 2
regained visual acuity of 20/400 or better. In contrast, only 2 of 9 eyes
in group 1 maintained their entry level visual acuity, and the visual
acuities of the remaining 7 eyes deteriorated to counting fingers or worse.
Therefore, the acute optic neuropathy complicating the acute retinal
necrosis syndrome appears to benefit from prompt recognition and surgical
decompression of the intraorbital optic nerve meninges in conjunction with
intravenous acyclovir.
