Acute retinal necrosis: Retinal detachment rates are unaffected by early treatment with intravitreal antivirals, vitrectomy

Ines Lains, MD, PhD

Ines Lains, MD, PhD, and colleagues from the Massachusetts Eye and Ear, Harvard Medical School, Boston, reported that adjunct treatment with intravitreal antivirals or early pars plana vitrectomy (PPV) did not improve the rates of retinal detachment (RD) in patients with acute retinal necrosis (ARN).

ARN is rare but can have devastating visual consequences, Lains explained. Over time, patients with ARN have a high risk of developing retinal traction and necrotic retinal breaks, which can lead to the development of a RD.

“RD is one of the most common consequences of ARN,” she said. Systemic antivirals are the mainstay treatment for ARN, and even though clinicians may empirically add intravitreal antivirals or early PPV, data on this topic remains controversial.

The investigators conducted a cross-sectional retrospective cohort study using IRIS Registry data to determine the association between the initial treatment regimen for ARN and RD rates at 6 and 12 months.

The researchers identified 533 eyes of 457 patients that met their criteria. Among them, 358 cases (67.2%) received only systemic antivirals, while 155 (29.1%) received adjunctive intravitreal antivirals, and 20 (3.8%) underwent early PPV.

Results of analysis of ARN data

“At 6 months, the rates of RD were comparable among eyes treated with systemic antivirals alone (19.6%), adjunctive intravitreal antivirals (18.7%, P = 0.80) and early PPV (25.0%, P = 0.51),” they reported. Similar results also were seen at the 12-month evaluation (P >0.47).

The results also showed that, compared to use of systemic antivirals alone, treatment with adjunctive intravitreal injections or early PPV did not affect the time to development of RDs (P > 0.47).

Lains commented, “To our knowledge, this is the largest dataset of patients with ARN that has been analyzed to date. Our results suggest that adjunctive treatment with intravitreal antivirals or early PPV do not improve rates of RD rates in patients with ARN. These findings are important because they support that, despite the theoretical advantages of these adjunctive strategies, systemic antivirals - the current mainstay of ARN treatment - are appropriate and provide similar outcomes, thus contributing to guide management of this blinding disease.”