Objective To evaluate the clinical features and treatment outcomes of acute retinal necrosis syndrome (ARNS) which caused by long-term usage of immunosuppressent drug. Methods The clinical data of 8 patients (12 eyes) with immunocompromised-related ARNS were retrospectively reviewed. The diagosis was made by medical history, slit-lamp microscopy, pre-set lenses check, serologic examination and fluorescein fundus angiography. The patients (2 males and 6 females) aged from 35 to 54 years, with the mean age of 44.2 years. Previous medical history included hematopathy (2 cases), thymus tumor (2 cases, one also with meningoencephalitis), meningoencephalitis (2 cases), systemic lupus erythematosus (1 case) and acute pneumonia (1 case). All patients received immunosuppressent therapy for a long time before ARNS occurred. The visual acuity was ＜0.05 (5 eyes, 41.7%), or 0.05-0.3 (3 eyes, 25.0%), or 0.3-1.0 (4 eyes, 33.3%). Those ARNS patients received antiviral therapy, laser photocoagulation and (or) surgery therapy. The mean followed-up period was 10.8 months (from 3 to 36 months). Results The eye sympotoms and uveitis of all patients were very mild, and their retinal vasculitis and retinal necrosis progressed slowly. Retinal vasculitis was involved in 4 quadrants (7 eyes), or 1-2 quadrants (2 eyes), or ＜1quadrant (3 eyes). Retinal necrosis extended from peripheral retina to mid- peripheral retina (10 eyes, 83.4%), or from peripheral retina to posterior pole (2 eyes, 16.6%). At the end of the follow-up period, the visual acuity of 7 eyes (58.3%) showed different degree of improvement. The follow-up visual acuity was ＜0.05 (4 eyes, 33.3%), or 0.05-0.3 (2 eyes, 16.6%), or 0.3-1.0 (6 eyes, 50%). Conclusions Immunocompromised ARNS patients had valid medical history and typical clinical features. However the eye sympotoms and uveitis were very mild, retinal vasculitis and retinal necrosis progressed slowly in this study. Early diagnosis and prompt therapy may save the visual acuity of those patients.
Objective To observe the therapeutic effects of ganciclovir (GCV) with different injection methods on experimental acute retinal necrosis (ARN). Methods The right eyes of 41 pigmented rabbits were infected by herpes simplex virus (HSV-1) (COS strain) to establish ARN animal model. After 24 and 72 hours, GCV was given by intravitreal injection (10 eyes), intravenous injection (11 eyes) and the intravitreal+intravenous injection (10 eyes); intravitreal injection of GCV and dexamethasone (6 eyes) was also included. Four eyes were not treated as the control. The dosage of GCV in intravitreal and intravenous injection was 800mu;g and 5mg/kg weight, respectively. Retina necrosis was observed and the grade was recorded 1-21 days after injection according to the grade standard of retinopathy. The maximum grades of retinal necrosis in different groups were compared. Results The grade of retinal necosis was 3.8 in the control group, and 0.2, 0.4, 0.8, and 2.2 in intravitreal injection, intravitreal+intravenous injection, intravitreal injection with GCV and dexamethasone, and intravenous injection, respectively, 24 hours after the model was set up. The effects of the first 3 groups were obviously better than the last group (P=0.003, 0.011, 0.045); while the difference among the first 3 groups were not significant (P=0.881、0.054、0.107). Seventy-two hours after the model was set up, the grades of retinal necrosis were above 1.4 in 4 groups, and the differences among the 4 groups were not apparent (P=0.214). Conclusions In the animal model of ARN, intravitreal injection with GCV can effectively decrease the grade of retinal necrosis. The difference among intravitreal injection, intravitreal+intravenous injection, intravitreal injection with GCV and dexamethasone, and intravenous injection is not significant.