A case of acute retinal necrosis: JAMA
An otherwise healthy woman in her 30s presented to an outside health care professional with a 2-day history of floaters in her left eye. She denied additional ocular symptoms and reported no relevant medical, ocular, or family history; medication use; or allergies. The findings of a review of systems were unremarkable.

A workup for posterior uveitis was initiated, and the patient began therapy with oral antiviral and oral corticosteroid medications. One week later, her symptoms had worsened, and she was referred for consultation.

Best corrected visual activity was 20/15 OD and 20/16 OS. Intraocular pressures, extraocular movements, visual fields by confrontation, and pupil responses were normal. Anterior segment examination and dilated fundus examination of the right eye had normal findings. However, the left eye had 3+ and anterior chamber cell and 1+ flare, non-granulomatous keratic precipitates, and a clear lens.

The dilated fundus examination revealed 2+ vitritis, a hyperemic disc with blurred margins, macular striae with a blunted foveal reflex, and vascular sheathing with segmental periarteriolar inflammatory plaques in multiple quadrants.

The peripheral retina had well demarcated peripheral retinal whitening with scalloped margins and intra-retinal hemorrhages in all quadrants (Figure 1A, B). Four days later, repeat fundus photography showed that the peripheral lesions had coalesced into larger circumferential necrotic regions (Fig 1C).

The patient received a diagnosis of acute retinal necrosis on the basis of clinical findings, with aqueous fluid polymerase chain reaction confirming varicella-zoster virus DNA. Multifocal, full thickness peripheral retinal whitening with scalloped borders and vitritis in a healthy adult is a classical presentation.

Read more here: https://jamanetwork.com/journals/jamaophthalmology/article-abstract/2702289
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