Retinal Detachment Linked to Poor Vision Outcomes in Acute Retinal Necrosis

Steven Yeh, MD

A new study observed poor initial visual acuity was significantly associated with retinal detachment in a cohort of patients with acute retinal necrosis.

“Retinal detachment is associated with poor visual outcomes in patients with acute retinal necrosis,” wrote study investigators led by Steven Yeh, MD, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center.

The findings suggest there was no clear difference observed in retinal detachment by viral etiology, although those with varicella zoster virus (VZV)-associated acute retinal necrosis were more likely to be older, male, and immunosuppressed.

The current research aimed to assess these and other risk factors for retinal detachment in acute retinal necrosis, using a retrospective cohort design. The included patients were those diagnosed with acute retinal necrosis at a tertiary referral center from 2010 to 2020.

Investigators performed a chart review for all clinical and surgical encounters. They utilized univariate and multivariate logistic analyses of demographic and clinical variables associated with retinal detachment. Survival analyses using Kaplan-Meier estimates were performed to compare time to retinal detachment in herpes simplex virus (HSV)- and VZV-associated acute retinal necrosis.

The main outcome measures included demographic information and clinical information, including visual acuity. Moreover, they measured intraocular pressure, intraocular inflammation level, the extent of retinitis, incidence and timing of retinal detachment, data of diagnosis, and treatments performed (including intravitreal injections of antiviral medications).

A total of 54 eyes of 47 patients diagnosed with acute retinal necrosis were included in the study. Investigators noted there was an equal proportion of eyes (n = 27, 50%) with VZV-acute retinal necrosis and HSV-acute retinal necrosis.

The data show the clinical characteristics, including initial visual acuity and IOP, anterior segment inflammation, clock hours, and posterior extent of retinitis, were similar eyes with VZV- and HSV-acute retinal necrosis.

Through the univariate analysis of clinical and demographic variables associated with development, investigators observed the initial visual acuity (P = .0083) and greater clock hours of retinitis (P = .009) were significantly associated with retinal detachment.

Each variable remained significant in the multivariate logistic regression. Data show worse visual acuity at presentation had an odds ratio (OR) of 2.34 (95% confidence interval [CI], 1.01 - 5.44; P = .042) and greater clock hours of retinitis had an OR of 1.23 (95% CI, 1.02 - 1.47; P = .025).

Kaplan-Meier survival analysis found no statistical difference in retinal detachment-free survival between HSV and VZV-acute retinal necrosis, according to the investigators.

“Poor initial VA and clock hours of retinitis were significantly associated with RD development and may be relevant for patient counseling and prognosis,” Yeh concluded.

The study, “Risk Factors for Retinal Detachment in Acute Retinal Necrosis,” was published in Ophthalmology.