Aqueous flare in acute retinal necrosis syndrome

Purpose Acute retinal necrosis syndrome (ARN) is a rapidly progressive viral necrotic retinitis. We used noninvasive measurement of aqueous flare to quantify blood-ocular barrier breakdown in eyes with ARN und to follow the inflammatory activity and treatment effects. Patients and Methods We report on seven patients (5 males und 2 females, age: 16 to 57 years) with ARN that were treated in our institution between 1991 to 1996. Aqueous flare was quantified regularily during treatment using the laser flare-cell meter (Kowa, FC-1000) following pupillary dilation. Results Aqueous flare was highly significantly increased in eyes with ARN (145.5+/-139.7, range 30 to 367 photon counts/ms). Contralateral, unaffected eyes showed normal flare values (3.6+/-0.8 photon counts/ms, p<0.0001; normals: 4.1+/-1.1 photon counts/ms). Flare values correlated with inflammatory activity before and during antiviral treatment. In two patients with ARN caused by herpes simplex-virus aqueous flare values were extremly increased (367 and 316 photon counts/ms), and retinal necrosis was rapidly progressive despite antiviral therapy. One patient developed early ARN in his contralateral eye with flare values increasing from 3.5 to 22.0 photon counts/ms, which quickly normalized following antiviral treatment. Conclusions Measurement with the laser flare-cell meter allows quantification of blood-ocular barrier breakdown in eyes with ARN und may be useful for monitoring inflammatory activity during treatment.