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__NOTOC__
__NOTOC__
{{SI}}
{{Acute retinal necrosis}}
{{CMG}}; {{AE}} {{Faizan}}


==Overview==
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
'''Acute retinal necrosis''' is a type of [[retinitis]] which can be associated with viral infections.


It was first characterized in 1971.<ref name="titleeMedicine - Acute Retinal Necrosis : Article by Andrew A Dahl, MD">{{cite web |url=http://www.emedicine.com/oph/topic377.htm |title=eMedicine - Acute Retinal Necrosis : Article by Andrew A Dahl, MD |accessdate=2008-02-05 |work=| archiveurl= http://web.archive.org/web/20080216011141/http://www.emedicine.com/oph/topic377.htm| archivedate= 16 February 2008 <!--DASHBot-->| deadurl= no}}</ref><ref>Urayama A, Yamada N, Sasaki T: Unilateral acute uveitis with retinal periarteritis and detachment. Jpn J Clin Ophthalmol 1971; 25: 607.</ref>
{{CMG}} {{AE}} {{LRO}}; {{Faizan}}


One study indicated an incidence of 1 per 1.6 to 2.0 million.<ref name="pmid17504853">{{cite journal |author=Muthiah MN, Michaelides M, Child CS, Mitchell SM |title=Acute retinal necrosis: a national population‐based study to assess the incidence, methods of diagnosis, treatment strategies and outcomes in the UK |journal=Br J Ophthalmol |volume=91 |issue=11 |pages=1452–5 |year=2007 |pmid=17504853 |doi=10.1136/bjo.2007.114884 |url=http://bjo.bmj.com/cgi/pmidlookup?view=long&pmid=17504853 |pmc=2095441}}</ref>
{{SK}} Retinal necrosis syndrome; Acute retinal necrosis syndrome; Necrotizing herpetic retinitis; Bilateral acute retinal necrosis


==Historical Perspective==
==[[Acute retinal necrosis overview|Overview]]==


==Classification==
==[[Acute retinal necrosis historical perspective|Historical Perspective]]==


==Pathophysiology==
==[[Acute retinal necrosis classification|Classification]]==


==Causes==
==[[Acute retinal necrosis pathophysiology|Pathophysiology]]==
The exact causes are not known, but [[varicella zoster virus]] is frequently implicated,<ref name="pmid17184841">{{cite journal |author=Lau CH, Missotten T, Salzmann J, Lightman SL |title=Acute retinal necrosis features, management, and outcomes |journal=Ophthalmology |volume=114 |issue=4 |pages=756–62 |year=2007 |pmid=17184841 |doi=10.1016/j.ophtha.2006.08.037 |url=http://linkinghub.elsevier.com/retrieve/pii/S0161-6420(06)01207-3}}</ref> and other [[herpesviridae|herpesviruses]] can be involved.<ref name="pmid17264500">{{cite journal |author=Kezuka T, Atherton SS |title=Acute retinal necrosis |journal=Chem Immunol Allergy |volume=92 |issue= |pages=244–53 |year=2007 |pmid=17264500 |doi=10.1159/000099275 |url=http://content.karger.com/produktedb/produkte.asp?doi=10.1159/000099275&typ=pdf |series=Chemical Immunology and Allergy |isbn=3-8055-8187-4}}</ref>


==Differentiating {{PAGENAME}} from Other Diseases==
==[[Acute retinal necrosis causes|Causes]]==


==Epidemiology and Demographics==
==[[Differentiating Acute retinal necrosis from other diseases|Differentiating Acute retinal necrosis from other Diseases]]==


==Risk Factors==
==[[Acute retinal necrosis epidemiology and demographics|Epidemiology and Demographics]]==


==Screening==
==[[Acute retinal necrosis risk factors|Risk Factors]]==


==Natural History, Complications, and Prognosis==
==[[Acute retinal necrosis screening|Screening]]==  
===Natural History===


===Complications===
==[[Acute retinal necrosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
 
===Prognosis===


==Diagnosis==
==Diagnosis==
===Diagnostic Criteria===
[[Acute retinal necrosis diagnostic criteria|Diagnostic Criteria]] | [[Acute retinal necrosis history and symptoms|History and Symptoms]] | [[Acute retinal necrosis physical examination|Physical Examination]] | [[Acute retinal necrosis laboratory findings|Laboratory Findings]] | [[Acute retinal necrosis electrocardiogram|Electrocardiogram]] | [[Acute retinal necrosis chest x ray|Chest X Ray]] | [[Acute retinal necrosis CT|CT]] | [[Acute retinal necrosis MRI|MRI]] | [[Acute retinal necrosis echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Acute retinal necrosis other imaging findings|Other Imaging Findings]] | [[Acute retinal necrosis other diagnostic studies|Other Diagnostic Studies]]
 
===Symptoms===
*Symptoms of Acute retinal necrosis include the following:<ref name="pmid17504853">{{cite journal |vauthors=Muthiah MN, Michaelides M, Child CS, Mitchell SM |title=Acute retinal necrosis: a national population-based study to assess the incidence, methods of diagnosis, treatment strategies and outcomes in the UK |journal=Br J Ophthalmol |volume=91 |issue=11 |pages=1452–5 |year=2007 |pmid=17504853 |pmc=2095441 |doi=10.1136/bjo.2007.114884 |url=}}</ref>
**[[Vision loss]]
***[[Blindness]] may be present in more severe cases
**[[Photophobia|Excessive sensitivity to light]]
**Ocular pain
**[[Flu]] symptoms
**[[Erythema|Redness]] of the affected eye
 
===Physical Examination===
 
===Laboratory Findings===
 
===Imaging Findings===
 
===Other Diagnostic Studies===


==Treatment==
==Treatment==
===Medical Therapy===
:*''' Empiric antimicrobial therapy'''
::*Preferred regimen: [[Acyclovir]] 10 mg/kg IV q8h for 1-2 weeks followed by [[Acyclovir]] 400 mg PO bid for chronic maintenance
::*Alternative regimen (1): [[Acyclovir]] 10 mg/kg IV q8h for 1-2 weeks followed by [[Valacyclovir]] 1 g IV q8h for 6 weeks to several months followed by [[Acyclovir]] 400 mg PO bid for chronic maintenance
::*Alternative regimen (2), unresponsive: [[Foscarnet]] 1.2-2.4 mg/0.1 mL intravitreal injection 1-3 times per week {{and}} ([[Ganciclovir]] 5 mg/kg IV q12 for 2 weeks followed by 5 mg/kg q24h for 5-7 weeks {{or}} [[Foscarnet]] 60 mg/kg IV q8h for 2 weeks followed by 90-120 mg/kg IV q24h {{or}} [[Cidofovir]] 5 mg/kg IV for 2 weeks followed by 5 mg/kg IV q2weeks) followed by ([[Acyclovir]] 400 mg PO bid for chronic maintenance {{or}} [[Valganciclovir]] 900 mg PO qd for chronic maintenance)
::*Note: [[Ganciclovir]] is administered for patients with suspected CMV acute retinal necrosis. Whereas [[Foscarnet]] is administered for patients who are not immunocompromised
:*''' Pathogen-directed antimicrobial therapy'''
::*'''HSV or VZV'''
:::*Preferred regimen: [[Acyclovir]] 10 mg/kg IV q8h for 1-2 weeks followed by [[Acyclovir]] 400 mg PO bid for chronic maintenance
:::*Alternative regimen: [[Acyclovir]] 10 mg/kg IV q8h for 1-2 weeks followed by [[Valacyclovir]] 1 g IV q8h for 6 weeks to several months followed by [[Acyclovir]] 400 mg PO bid for chronic maintenance
::*''' Cytomegalovirus'''
:::*Preferred regimen: [[Foscarnet]] 1.2-2.4 mg/0.1 mL intravitreal injection 1-3 times per week {{and}} [[Ganciclovir]] 5 mg/kg IV q12 for 2 weeks followed by 5 mg/kg q24h for 5-7 weeks followed by [[Valganciclovir]] 900 mg PO qd for chronic maintenance
===Surgery===
===Prevention===


==See also==
[[Acute retinal necrosis medical therapy|Medical Therapy]] | [[Acute retinal necrosis surgery|Surgery]] | [[Acute retinal necrosis primary prevention|Primary Prevention]] | [[Acute retinal necrosis secondary prevention|Secondary Prevention]] | [[Acute retinal necrosis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Acute retinal necrosis future or investigational therapies|Future or Investigational Therapies]]
* [[Cytomegalovirus retinitis]]
* [[Progressive outer retinal necrosis]]


==External links==
==Case Studies==
* http://www.iceh.org.uk/files/tsno8/text/18.htm
[[Acute retinal necrosis case study one|Case #1]]
* http://www.eyepathologist.org/disease.asp?IDNUM=301330


==References==
==Source==
{{reflist|2}}
[http://eyewiki.aao.org/Acute_retinal_necrosis American Academy of Ophthalmology]
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{{WikiDoc Sources}}


[[Category:Disease]]
[[Category:Ophthalmology]]
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Latest revision as of 20:16, 29 July 2020

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Overview

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Epidemiology and Demographics

Risk Factors

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Natural History, Complications and Prognosis

Diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.; Faizan Sheraz, M.D. [2]

Synonyms and keywords: Retinal necrosis syndrome; Acute retinal necrosis syndrome; Necrotizing herpetic retinitis; Bilateral acute retinal necrosis

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Acute retinal necrosis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria | History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | Chest X Ray | CT | MRI | Echocardiography or Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

Source

American Academy of Ophthalmology

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