Individuals who develop retinal detachments (RD) following acute retinal necrosis (ARN) associated with the varicella zoster virus (VZV) are often older and are more likely to be men than those with ARN associated with the herpes simplex virus (HSV), a report shows. Those with VZV-ARN are also more likely to be immunocompromised. However, once they progress to RD, any differences between the 2 groups is insignificant, according to research published in Ophthalmology Retina

The study examined risk factors related to RD in 54 eyes of 47 patients diagnosed with ARN, who were split evenly between those with VZV-ARN and those with HSV-ARN. 

In either case, initial visual acuity (P =.0083), initial intraocular pressure (IOP), anterior segment inflammation, clock hours of retinitis (P =.009), and posterior extent of retinitis are correlated with a significant risk for RD. 


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The link between diminished initial visual acuity and RD development has not been elucidated. However, the researchers speculate that likely mechanisms include optic neuropathy, more posterior retinitis, or worse vitreous- and anterior-segment inflammation. These factors could have also increased the risk of RD. 

The researchers noted a greater than 50% rate of RD was on follow-up, with some manifesting more than a year after ARN diagnosis. They did not determine any differences in RD-survival rates between the VZV-ARN and HSV-ARN groups.

Investigators add that they “confirmed that retinitis extent is significantly associated with risk for RD, and […] that initial visual acuity is also significantly associated with risk of RD.”

Limitations of the study include its retrospective design and variable follow-up interval. Bias could have existed toward eyes that were more diseased and at greater RD risk because patients without continuing symptoms may not present to the clinic. The tertiary nature of the clinic could have biased towards more severe or higher-risk presentations.

Reference

Bavinger J, Anthony C, Lindeke-Myers A, et al. Risk factors for retinal detachment in acute retinal necrosis. Ophthalmol Retina. Published online January 21, 2022. doi:10.1016/j.oret.2022.01.016