Acute retinal necrosis: How can we manage it?

Author: Francisco Manuel Hermoso Fernandez (Spain)

Co-authors: Maria Carmen Gonzalez Gallardo, María Cruz Rojo, Jose Luis García Serrano

Purpose

To report a case showing an acute retinal necrosis (ARN) and to emphasize special aspects of the management. Factors that have to be taken into account.

Setting/Venue

Department of Ophthalmology of the San Cecilio University Hospital of Granada, Spain.

Methods

We present an 83-year-old woman examined for acute vision loss in her left eye (LE), Background: diabetes, pseudophakic in her LE; intraocular lens (IOL) subluxated and advanced pseudoexfoliative glaucoma in her right eye (RE) . The visual acuity (VA) was hand movements’ in both eyes. Funduscopic examination revealed vitritis, temporal area of retinal necrosis with peripapillary choroiditis’ spots and macular haemorrhages in her LE and OCT showed a cystic macular edema.

Results

A 53-year-old woman who goes to the emergency for acute painless vision loss of about 3 hours of evolution in her right eye(OD). Visual acuity in her left eye was (OS)=1 and hand movement in the right eye (OD). Marcus-Gunn sign in OD. Fundoscopy examination revealed a yellow embolus lodged at the level of papillary area that extends into the inferior temporal artery provoking peri-foveolar retinal edema with “cherry red spot”. Laser YAG was applied for photo-fragmentation of the embolus. We use YAG laser at 0.5 mJ, applying a total of 15 shots, then continuing with eye massage every 30 minutes for 2 hours. After that, we observed the appearance of laminar flow and repermeabilization of the artery. The visual acuity was AV(OD)= 1/30=0,33 24h later. The pupil was hyporeactive, the embolus and the retinal edema had disappeared.

Conlusions

The YAG laser seems to be a hopeful technique in visual recovery and early vascular repermeabilization in CRAO with visible embolism performed in the first 6 hours post-occlusion, although it is not exempt from adverse effects such as vitreous hemorrhage. In our case, the early fragmentation of the embolus with YAG laser has allowed the repermeabilization of the vessel and a modest improvement in visual acuity. The patient must be made aware of the poor visual prognosis and know the origin of the thrombus to avoid recurrences.

Financial Disclosure

No financial disclosure