Acute Retinal Necrosis Secondary to HSV-2

Acute retinal necrosis is a rare entity clinically defined by one or more foci of retinal necrosis in the peripheral retina with circumferential spread and rapid progression in the absence of therapy. It typically includes an occlusive vasculopathy and prominent vitreous or anterior chamber inflammation. Here, we present a case of a patient with left eye discomfort for three days. Her exam was notable for significant anterior chamber and vitreous inflammation, as well as peripheral, pinpoint areas of retinal whitening throughout the periphery. While her clinical picture did not exemplify the classic presentation of ARN, her peripheral retinal whitening prompted an anterior chamber paracentesis, which lead to the confirmatory diagnosis of HSV-2 induced acute retinal necrosis. Even with aggressive treatment with both intravitreal and systemic antiviral therapy, she ultimately developed a retinal detachment, requiring surgery with vitrectomy, scleral buckle, and silicone oil placement. Despite her disease’s progression to a retinal detachment, the patient fared well post-operatively. Our case reviews the management of acute retinal necrosis, which is greatly limited by the rarity of the disease. We compare the roles of systemic and combination antiviral therapy; we furthermore discuss the controversial topic of prophylactic vitrectomy and laser therapy in preventing retinal detachments. Our case highlights the idea of early and aggressive diagnosis and treatment of retinal whitening to improve visual and anatomical outcomes.

Presentation Date: 05/20/2021

Issue Date: 06/04/2021