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ACUTE RETINAL NECROSIS BY YUSUKE OSHIMA, MD, PhD

A 72-year-old woman presented with complaints became larger, increased in number, and coalesced The final goals for the treatment of this of gradual vision loss in her left eye (OS) after dialysis within 1 week after the initial visit (Inset, middle). patient’s acute retinal necrosis include halting the treatment. The patient’s best corrected visual acuity Because systemic antiviral administration is a retinal necrosis in order to avoid subsequent retinal OS was 20/200. Inflammatory cells were noted in the concern in patients with chronic kidney failure, urgent detachment and optic atrophy, while minimizing the anterior chamber with keratic precipitates on slit-lamp 25-gauge standardized three-port vitrectomy with collateral damage caused by and vascu- examination. Fundus examination revealed slight vitre- intravitreal perfusion of ganciclovir was performed lar occlusions, thereby preventing severe vision loss. ous haze with multiple white-yellow patched retinal before a definitive diagnosis of acute retinal necrosis The initiation of systemic and local antiviral treatment lesions in the far periphery (Main Figure). Optic disc was made. The posterior hyaloid was detached, and along with surgical intervention immediately after the swelling was also detected OS. Fluorescein angiography epiretinal membrane and internal limiting membrane clinical diagnosis in this case may be key to restoring revealed hyperfluorescence around the patched lesions peeling was performed to remove the scaffold of the patient’s useful vision and avoiding the late onset and prominent areas of leakage from the optic nerve, secondary proliferation. Prophylactic retinal laser of complications of acute retinal necrosis. n suggesting inflammation with retinal vasculitis and photocoagulation was applied around 360° at the vascular occlusions (Inset, left). periphery to create a broad border and to prevent Based on these findings, acute retinal necrosis was subsequent in the areas of retinal SECTION EDITOR MANISH NAGPAL, MS, DO, FRCS (EDIN) suspected. Immediate paracentesis was carried out to necrosis. The surgery was concluded with silicone oil n Senior Consultant, Retina and Vitreous Services, at obtain an aqueous sample for polymerase chain reaction tamponade after fluid-air exchange. the Retina Foundation in Ahmedabad, India analysis. Retinal laser photocoagulation was then Three months after surgery, the patient’s visual acuity n [email protected] applied to the border of the white-yellow patched lesions remained 20/100 OS with no secondary membrane to prevent the late consequence of retinal detachment. proliferation or retinal detachment. Her visual field, YUSUKE OSHIMA, MD, PhD Intravitreal ganciclovir and a systemic corticosteroid however, was severely narrowed due to atrophic changes n Founder and Director, Vitreoretinal & Cataract were administered concurrently to prevent the progres- in the optic nerve (Inset, right). Aqueous humor polymerase Surgery Center, Oshima Eye Clinic, Takatsuki-city, sion of retinal necrotizing and vascular inflammation. chain reaction analysis led to a diagnosis of necrotizing Osaka, Japan Despite these intensive therapies, the patched lesions herpetic caused by varicella zoster . n [email protected]

If you have an image or images you would like to share, email Dr. Nagpal. Note: Photos should be 400 dpi or higher and at least 10 inches wide. APRIL 2018 | RETINA TODAY 35