Acute retinal necrosis surgery
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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.
Overview
Surgery is not the first-line treatment option for patients with acute retinal necrosis; it is primarily indicated when there is a substantial risk of complications, including retinal detachment and tissue atrophy.
Surgery
Surgery is not the first-line treatment option for patients with acute retinal necrosis; it is primarily indicated when there is a substantial risk of complications, including retinal detachment and tissue atrophy.[1]
Vitrectomy
Vitrectomy may be indicated both before and after occurrence of retinal detachment to improve visual prognosis.[2]
- Prophylactic vitrectomy can be effective in removing inflammation factors, preventing retinal detachment by removing or preventing the spread of pre-existing lesions and necrotic tissue.[3]
- Remedial vitrectomy in patients experiencing retinal detachment can lead to improved visual prognosis by retinal reattachment.[4]
The success of vitrectomy in improving outcomes is dependent on the time between the onset of acute retinal necrosis and the time at which the procedure is performed.[2]
- Increased extent of necrosis and larger size, as well as posterior located, lesions was associated with worse visual prognosis despite prophylactic or remedial vitrectomy.
- Prophylactic vitrectomy is often encouraged to maximize efficacy, performed in the early stages of ARN.
Prophylactic Laser Retinopexy
Prophylactic laser retinopexy may be indicated to prevent retinal detachment by photocoagulation, creating posterior chorioretinal adhesions.[5][6]
- The procedure is contraindicated if there is vitreous inflammation or obstructed view and access to the posterior pole.
Due to reported occurrences of retinal detachment from prophylactic laser photocoagulation, more research is necessary to determine the ideal indications for the procedure.[5]
- If performed on patients with excessive inflammation and vitreous opacity, there is evidence of photocoagulation worsening prognosis of acute retinal necrosis, leading to retinal detachment and blindness.[3]
References
- ↑ Shantha JG, Weissman HM, Debiec MR, Albini TA, Yeh S (2015). "Advances in the management of acute retinal necrosis". Int Ophthalmol Clin. 55 (3): 1–13. doi:10.1097/IIO.0000000000000077. PMC 4567584. PMID 26035758.
- ↑ 2.0 2.1 Luo YH, Duan XC, Chen BH, Tang LS, Guo XJ (2012). "Efficacy and necessity of prophylactic vitrectomy for acute retinal necrosis syndrome". Int J Ophthalmol. 5 (4): 482–7. doi:10.3980/j.issn.2222-3959.2012.04.15. PMC 3428546. PMID 22937510.
- ↑ 3.0 3.1 Kawaguchi T, Spencer DB, Mochizuki M (2008). "Therapy for acute retinal necrosis". Semin Ophthalmol. 23 (4): 285–90. doi:10.1080/08820530802111192. PMID 18584565.
- ↑ McDonald HR, Lewis H, Kreiger AE, Sidikaro Y, Heckenlively J (1991). "Surgical management of retinal detachment associated with the acute retinal necrosis syndrome". Br J Ophthalmol. 75 (8): 455–8. PMC 1042429. PMID 1873262.
- ↑ 5.0 5.1 Park JJ, Pavesio C (2008). "Prophylactic laser photocoagulation for acute retinal necrosis. Does it raise more questions than answers?". Br J Ophthalmol. 92 (9): 1161–2. doi:10.1136/bjo.2008.147181. PMID 18723739.
- ↑ Chun HL, Missotten T, Salzmann J, Lightman SL (2007). "Acute Retinal Necrosis: Features, Management, and Outcomes". Opthalmology. 114: 756–762. Unknown parameter
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