An algorithm for managing surgical patients with acute retinal necrosis

Purpose. To increase the efficiency of surgical treatment and develop an algorithm for managing patients with the consequences of acute retinal necrosis (ARN).

Material and methods. The study included 35 patients (42 eyes) aged 18 to 74 with acute retinal necrosis. All patients underwent a microinvasive (23 Ga) vitrectomy with membrane peel, endolaser coagulation of the retina and endotamponade of the vitreal cavity with silicone oil. The operated eyes were divided into 2 groups. The main group consisted of 17 eyes with a clinical picture of fibrosis of the vitreous without retinal detachment (10 eyes) and retinal detachment without pronounced fibrosis of the vitreous (7 eyes). The comparison group included 25 eyes which had retinal detachment and fibrosis of the vitreous at the time of surgery. The visual acuity varied between incorrect light projection and 0.15 with correction.

Results. A stable anatomical and optical result was achieved in all cases. Complete adhesion of the detached retina was achieved in 94.1 %, which is explained by the fact that surgical treatment was in most cases performed in the absence of pronounced stages of proliferative vitreoretinopaty. In all cases of the main group, an increase in visual acuity was noted. In 53 % of cases, visual acuity achieved 0.1 to 0.3 and in the remaining 47 % it was 0.3 % or above. This can be accounted for by the prevalence of peripheral necrotic lesions, as well as a lower incidence of macular edema and optic neuropathy. However, in the comparison group, an increase in visual acuity was only observed in 56 % cases, with visual acuity reaching 0.1 or higher only in 24 % of the eyes. A high frequency (72 %) of necrosis expansion to the posterior eye pole with an irreversible damage to the optic nerve and the macular region was revealed.

Conclusion. Active dynamic observation of patients with ARN helps detect changes requiring surgical treatment, which leads to higher functional and anatomical outcomes, as well helps avoid the disability of the patients. Surgical treatment prior to the formation of retinal detachment in severe traction syndrome with or without retinal tears is advisable. An algorithm was proposed for managing surgical patients, depending on the clinical manifestations of ARN effects.

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