Clinical features and management of eyes with acute retinal necrosis presenting with rhegmatogenous retinal detachment

Purpose:To study clinical features, anatomical and visual outcomes in eyes having rhegmatogenous retinal detachment (RD) as the presenting feature of acute retinal necrosis (ARN).Materials and Methods:We conducted a retrospective cohort study of patients with ARN (active/healed) and concomitant RD at the presenting visit.Results:The median age of patients was 36 years, with a male preponderance (9:1). Bilateral ARN was observed in 60% of cases, with 50% of patients testing positive for human immunodeficiency virus. The duration between the onset of symptoms and presentation was 3.66 +/- 2.26 weeks. At presentation, 53.3% of eyes had active retinitis. Vitreoretinal surgery with silicone oil tamponade was performed for 14 eyes. Visual acuity significantly improved in 3 months (P = 0.0027). Poor visual outcomes were associated with optic nerve involvement. The mean duration of silicone oil tamponade was 7.41 +/- 4.48 months. Complications included recurrent RD (14.29%), epiretinal membranes (14.29%), cystoid macular edema (21.4%), and retinal scarring with atrophy.Conclusion:ARN with RD at presentation is a unique medical and surgical challenge, wherein good anatomical and functional outcomes could be achieved. The large size of retinitis and delayed presentation were the risk factors associated with poor visual outcomes.