Presenters: Shaikha Aljneibi & Aniruddha Agarwal, Cleveland Clinic Abu Dhabi

Case Summary:

A 33-year-old male patient was referred to our Eye clinic with complaints of eye pain in the right eye (OD) for the past 10 days. This was associated with blurring of vision and headache. The past medical history was significant for congenital adrenal hyperplasia which was being treated with 5 mg oral prednisolone daily and 0.1 mg fludrocortisone once a day. The initial assessment in our clinic revealed a best-corrected visual acuity of 20/60 in OD and 20/25 in the left eye (OS). The intraocular pressure (IOP) was 14 mm Hg in both eyes. The pupils were equal in size and reacting normally. Anterior segment of OD revealed 4+ cells and flare, and dilated fundus examination revealed 2+ vitreous cells and confluent, 360-degree necrotic white lesions with arteriolar sheathing and hemorrhages. Examination of OS was unremarkable. The clinical examination was consistent with the diagnosis of acute retinal necrosis (ARN) in OD. Notably, the optical coherence tomography (OCT) scan revealed “cavernous pattern” of retinal necrosis with destruction of retinal layers. The patient was admitted and received intravenous acyclovir 10mg/kg every 8 hours for 10 days along with intravitreal foscarnet (2 doses). Three weeks after initial presentation, the patient developed a rhegmatogenous retinal detachment with a large sieve-like retinal break infero-temporally. He underwent OD pars plana vitrectomy with internal limiting membrane peeling, and silicone oil tamponade. Postoperatively, the patient had an attached retina with healed retinitis lesions, visual acuity of 20/150, and OCT did not show any epiretinal membrane or macular edema.