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Factors at the initial visit associated with poor visual outcomes in patients with acute retinal necrosis

Eye (2024)Cite this article

Subjects

Abstract

Background/Objective

Acute retinal necrosis (ARN) is a vision-threatening disease caused by herpesvirus infection. This study aimed to investigate the visual prognostic factors that could be determined at the initial visit.

Subjects and Methods

This retrospective study included 34 patients with ARN. Logistic regression analysis was employed to evaluate the associations between poor final visual outcomes and various factors, including poor initial visual acuity, presence of retinal detachment at the initial visit, posterior extension of necrotizing retinitis, and circumferential extension of necrotizing retinitis. Posterior extension was evaluated with three zonings, from the periphery (zone 3), mid-periphery (zone 2), and macula (zone 1). Circumferential extension was evaluated according to the degree of necrotizing retinitis lesions using ultra-wide fundus imaging.

Results

The mean logarithm of the minimum angle of resolution was 0.63 ± 0.68 at the initial visit and 0.83 ± 0.65 at 12 months after the initial visit. Seven patients had a retinal detachment. The distribution of posterior extension at the initial visit was 5 in zone 1, 20 in zone 2, and 9 in zone 3. The average of necrotizing retinitis lesion angle was 249 ± 115°. The logistic regression analysis revealed that participants with wide angles of necrotizing retinitis were associated with final poor vision, with an odds ratio of 1.28 per 30° increase (95%CI: 1.00–1.65, p = 0.03).

Conclusions

Assessment of the widespread circumferential extension of white necrotizing retinal lesions at the initial visit is a crucial risk factor for the visual prognosis in ARN.

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Fig. 1: BCVA in patients with ARN based on necrotizing retinal lesions extents around 180°.
Fig. 2: Final BCVA in patients with ARN based on zone classification.
Fig. 3: BCVA in patients with ARN who had necrotizing retinal lesions in zone 2 based on necrotizing retinal lesions extents around 180°.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank Editage for English language editing.

Funding

This study was supported by grants from the Japan Society for the Promotion of Science (JSPS) through JP21K09745 and JP24K12810 (Grant C to AT), the Ministry of Education, Science, Sports, and Culture of Japan (Tokyo, Japan), the Japan Agency for Medical Research and Development (AMED) through grand number 23jk0210042h0001 (NY: Tokyo, Japan), Alcon Pharma Research Grants (AT; Tokyo, Japan) and AMO Japan Research Grants (AT; Tokyo, Japan). The funding sources had no role in the design and conduct of the study.

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Authors and Affiliations

  1. Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Chihiro Fukui, Atsunobu Takeda, Eiichi Hasegawa, Kenichiro Asahara, Mariko Shirane, Hiroki Tsutsui, Keiko Yoshitomi, Takako Ito, Masato Akiyama, Shoji Notomi, Keijiro Ishikawa, Yusuke Murakami, Nobuyo Yawata & Koh-Hei Sonoda

  2. Department of Ophthalmology, Faculty of Medicine, Oita University, Yufu, Oita, Japan

    Chihiro Fukui & Atsunobu Takeda

  3. Department of Ophthalmic Function and Regenerative Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Takako Ito

  4. Department of Ocular Pathology and Imaging Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Masato Akiyama & Nobuyo Yawata

  5. Department of Ophthalmology, Chikushi Hospital, Fukuoka University, Chikushino, Fukuoka, Japan

    Toshio Hisatomi

  6. Singapore Eye Research Institute, Singapore, Singapore

    Nobuyo Yawata

  7. Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore

    Nobuyo Yawata

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  1. Chihiro Fukui
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Contributions

Concept and design of the work: CF, AT, NY; Acquisition or interpretation of data: CF, EH, KA, MS, HT, KY, TI, KI, YM, TH; Analysis of data: CF, AT, NY; Drafting of the manuscript: CF, AT; Statistical analysis: CF, MA; Critical revision of the article: EH, NY, KHS.

Corresponding author

Correspondence to Atsunobu Takeda.

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Fukui, C., Takeda, A., Hasegawa, E. et al. Factors at the initial visit associated with poor visual outcomes in patients with acute retinal necrosis. Eye (2024). https://doi.org/10.1038/s41433-024-03207-w

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