Acute retinal necrosis surgery
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Acute retinal necrosis Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.
Overview
Surgery is not the first-line treatment option for patients with acute retinal necrosis; it is primarily indicated when there is a substantial risk of complications, including retinal detachment and tissue atrophy.
Surgery
Surgery is not the first-line treatment option for patients with acute retinal necrosis; it is primarily indicated when there is a substantial risk of complications, including retinal detachment and tissue atrophy.[1]
Vitrectomy
- Vitrectomy may be indicated both before and after occurrence of retinal detachment to improve visual prognosis.[2]
- Prophylactic vitrectomy can be effective in removing inflammation factors, preventing retinal detachment by removing or preventing the spread of pre-existing lesions and necrotic tissue.[3]
- Remedial vitrectomy in patients experiencing retinal detachment can lead to improved visual prognosis by retinal reattachment.[4]
- The success of vitrectomy in improving outcomes is dependent on the onset of Acute retinal necrosis relative to the time the procedure is performed.[2]
- Increased extent of necrosis and larger size, as well as posterior located, lesions were associated with worse visual prognosis despite prophylactic or remedial vitrectomy.
- Prophylactic vitrectomy is often encouraged to maximize efficacy, performed in the early stages of ARN.
Prophylactic Laser Retinopexy
- Prophylactic laser retinopexy may be indicated to prevent retinal detachment by photocoagulation, creating posterior chorioretinal adhesions.[5]
- The procedure is contraindicated if there is vitreous inflammation or obstructed view and access to the posterior pole.
- Due to reported occurrences of retinal detachment from prophylactic laser photocoagulation, more research is necessary to determine the ideal indications for the procedure.[5]
- If performed on patients with excessive inflammation and vitreous opacity, there is evidence of photocoagulation worsening prognosis of Acute retinal necrosis, leading to retinal detachment and blindness.[3]
References
- ↑ Shantha JG, Weissman HM, Debiec MR, Albini TA, Yeh S (2015). "Advances in the management of acute retinal necrosis". Int Ophthalmol Clin. 55 (3): 1–13. doi:10.1097/IIO.0000000000000077. PMC 4567584. PMID 26035758.
- ↑ 2.0 2.1 Luo YH, Duan XC, Chen BH, Tang LS, Guo XJ (2012). "Efficacy and necessity of prophylactic vitrectomy for acute retinal necrosis syndrome". Int J Ophthalmol. 5 (4): 482–7. doi:10.3980/j.issn.2222-3959.2012.04.15. PMC 3428546. PMID 22937510.
- ↑ 3.0 3.1 Kawaguchi T, Spencer DB, Mochizuki M (2008). "Therapy for acute retinal necrosis". Semin Ophthalmol. 23 (4): 285–90. doi:10.1080/08820530802111192. PMID 18584565.
- ↑ McDonald HR, Lewis H, Kreiger AE, Sidikaro Y, Heckenlively J (1991). "Surgical management of retinal detachment associated with the acute retinal necrosis syndrome". Br J Ophthalmol. 75 (8): 455–8. PMC 1042429. PMID 1873262.
- ↑ 5.0 5.1 Park JJ, Pavesio C (2008). "Prophylactic laser photocoagulation for acute retinal necrosis. Does it raise more questions than answers?". Br J Ophthalmol. 92 (9): 1161–2. doi:10.1136/bjo.2008.147181. PMID 18723739.