Thirty patients (37 eyes) were retrospectively included in this study. The eyes were divided into 2 groups by treatment, including routine treatment, which consisted of
antiviral medication and
vitrectomy after
retinal detachment (RD) (n=21), and prophylactic
vitrectomy, which consisted of
antiviral medication and
vitrectomy for the prevention of RD performed during the active inflammatory phase (n=16). The extent of
necrosis was determined by fundus photographs at the time of presentation (for eyes with mild vitreous opacity) or the drawings in the operation records.
Necrosis of the 37 eyes was divided into 3 grades, including peripheral, middle-peripheral and extensive. The follow-up period ranged from 8 to 57 months. Differences in visual acuity and
necrosis between groups were identified using independent samples t-test.
RESULTS:
Necrosis was more extensive in the routine treatment group than in the prophylactic
vitrectomy group (P<0.05). In the routine treatment group,
conservative treatment improved
necrosis and prevented RD in 6 eyes (29%). Seven eyes (33%) obtained anatomical success, but
retinal redetachment occurred in 8 eyes (57%). There were also 5 eyes (24%) developed
ocular hypotony or
atrophy. Ten eyes (48%) achieved equal or increased visual acuity. In the prophylactic
vitrectomy group, RD occurred in 2 eyes (13%). Twelve eyes (75%) were completely anatomically successful, and 10 eyes underwent
silicone oil removal. Only one eye (6%) became
ocular hypotony. Fourteen eyes (88%) achieved equal or increased visual acuity. The prophylactic
vitrectomy group achieved better vision trends than the routine treatment group (P<0.05). Eyes with peripheral
necrosis had better visual outcomes than those with mid-peripheral (P<0.05) or extensive (P<0.05)
necrosis. However, there was no significant difference between eyes with mid-peripheral and extensive
necrosis (P=0.3008)
CONCLUSION: Prophylactic
vitrectomy can prevent RD and improve the prognosis of ARN, making it an option for cases with rapidly progressing
necrosis despite
antiviral treatment and cases with moderate to extensive
necrosis and severe vitreous opacity.