Can viral infection-related acute retinal necrosis contribute to retinal detachment?

USA: A new study conducted by J. Clay Bavinger and the team shows that varicella-zoster virus-associated acute retinal necrosis ((VZV-ARN) patients were more likely to be older and immunocompromised than those with herpes simplex virus-associated acute retinal necrosis (HSV-ARN). The findings of this study were published in Ophthalmology Retina.

The researchers, however, observed no clear difference in retinal detachment (RD) by viral etiology. Poor initial visual acuity and clock hours of retinitis were notably linked with the development of retinal detachment and may be relevant for patient prognosis and counseling. 

All clinical and surgical contacts were subjected to a chart review. The demographic and clinical factors related to RD were subjected to univariate and multivariate logistic analysis. Survival studies using Kaplan-Meier estimates were used to examine the time to RD in ARN caused by herpes simplex virus (HSV) and VZV. Demographic information, clinical information (including visual acuity [VA]), intraocular inflammation level, intraocular pressure (IOP), the degree of retinitis, incidence, and timing of retinal detachment, date of diagnosis, and therapies undertaken were the primary outcomes of this study (including intravitreal injections of antiviral medications).

The key findings of this study were as follows:

1. 54 eyes from 47 patients with ARN were included, with similar proportions of VZV-ARN and HSV-ARN.

2. Those with VZV-ARN were older, more likely to be men, and more likely to be immunocompromised than patients with HSV-ARN.

3. Clinical features such as first VA, initial IOP, clock hours, anterior segment inflammation, and posterior extent of retinitis were similar in VZV- and HSV-ARN eyes.

4. Initial VA and higher clock hours of retinitis were substantially linked with RD in a univariate study of clinical and demographic factors associated with the development of RD.

5. In the multivariate logistic regression, these two factors remained significant; worse VA at presentation had an odds ratio of 2.34, and more clock hours of retinitis had an odds ratio of 1.23.

6. A Kaplan-Meier survival analysis found no statistically significant difference in RD-free survival between HSV-ARN and VZV-ARN.

In conclusion, the authors found that poor initial Visual acuity and retinitis clock hours were substantially related to Retinal detachment development and may be useful for patient counseling and prognosis in the future.

Reference:

Bavinger, J. C., Anthony, C. L., Lindeke-Myers, A. T., Lynch, S., Xu, L. T., Barnett, J., Levine, D., Patel, P., Shah, R., Jain, N., Rao, P., Hendrick, A., Cribbs, B. E., Yan, J., Hubbard, G. B., III, Shantha, J. G., O'Keefe, G. D., & Yeh, S. (2022). Risk Factors for Retinal Detachment in Acute Retinal Necrosis. In Ophthalmology Retina (Vol. 6, Issue 6, pp. 478–483). Elsevier BV. https://doi.org/10.1016/j.oret.2022.01.016