Acute retinal necrosis in the children: the clinical manifestations and the results of the treatment

We investigated the clinical manifestations and the results of the treatment of acute retinal necrosis in 9 children at the age from 6 to 16 (mean 11.2) years. The clinical course of the disease was characterized by severe and often unilateral panuveitis with the typical peripheral chorioretinal lesions spreading circularly and rapidly progressing in the absence of antiviral therapy. Recularity of the disease in children was a more aggressive clinical course with severe vitriitis and membrane formation in the vitreous body and the absence of vaso-occlusion. The serological study revealed the markers of the type 2 herpes simplex virus and cytomegalovirus activation in 8 and 5 children respectively. This fact may be regarded as indirect evidence of the etiological role of this pathogens in the development of acute retinal necrosis. The combined antiviral and anti-inflammatory treatment allowed to achieve the remission of the disease; however, in 6 children developed traction-regmatogenous retinal detachment. Vitrectomy with retinal endolaser coagulation and tamponade of the vitreal cavity using the silicone oil resulted in retinal reattachment in all the four patients treated by this method. It is concluded that early diagnostics, active combined therapy and preventive laser photocoagulation of the peripheral chorioretinal lesions after active retinitis create the necessary prerequisites for the successful treatment of acute retinal necrosis.

acute retinal necrosis, children, herpes virus, retinal detachment, vitrectomy