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Case Study: Acute Retinal Necrosis by Varicella-Zoster Virus

Detailed case study of a 27-year-old male with ARN induced by VZV, treatment, and outcomes. Importance of early intervention and combination therapy discussed.

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Case Study: Acute Retinal Necrosis by Varicella-Zoster Virus

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  1. Dr. Rathinam Sivakumar HOD - Uveitis Services Dr. Radhika. T Consultant, Uveitis Service Dr. Vedhanayaki Rajesh Consultant, Uveitis Service Acute Retinal Necrosis

  2. OcularHistory 27 yearold male OD: defectivevision, painandredness since 15 days nospecificsystemicillness

  3. First Presentation VA: OD 6/36, OS 6/6 IOP: OD 18mm Hg; OS 18mm Hgby NCT OD: granulomatousKP's on endothelium AC 3+ cells; flare 2+ AVF 3+ cells; retinalnecrosis with sclerosedvessel OS: quieteye

  4. First Presentation – Lab Findngs Routine baselineinvestigationswereperformedandwerewithin normal limits HIV Tridot -ve Vit. Tap : PCR +vefor VZV

  5. Diagnosis Acuteretinalnecrosis inducedbyvaricella-zoster virus

  6. Treatment steroid with antibiotics e/d – taperingtherapy homatropine e/d twice/day – 1 week Topicalganciclovir gel 3x/day oral valacyclovir 1gm 3x/day oral prednisolonetaperedweeklyfrom 40 mg/ weekto 10mg (4 weeks) intravitreal gancyclovir (2mg / 0.1 ml)

  7. Second Presentation – After 3 weeks VA: OD 6/9, OS 6/6 IOP: OD 10mm Hg; OS 18mm Hgby NCT OD: AC quiet; HealingRetinalnecrosis OS: Quieteye Patient was continued on oral valacyclovir

  8. Third Presentation – After oneMonth VA: OD 5/60, OS 6/6 OD: AC – Occ. Cells fundus: retinaldetachment (post ARN) pars plana vitrectomy +/- membranepeeling + endolaser + siliconeoilimplantation continued on oral valacyclovir

  9. Final Presentation – After 1 Month BCVA: OD 6/9, OS 6/6 OD: AC – Quiet Fundus: siliconeoilfilledglobe settledretinaldetachment

  10. Conclusion • ARN ischaracterisedbyacuteperipheralnecrotisingretinitis, retinal arteriolitis with severe vitritis • Itcanbecausedby VZV / HSV in both immunocompetent andcompromisedpatients • Retinitis progressesrapidly in theabsenceoftreatment. Rhegmatogenous retinaldetachmentcanoccurfromatrophicareaspostretinalnecrosis • Intravitreal Gancyclovirand oral antiviral therapyarethebesttreatmentoptions. Corticosteroidsareinitiated with anti-virals in taperingregimen

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