ObjectiveTo investigate the influencing factors of secondary retinal detachment (RD) in patients with acute retinal necrosis syndrome (ARN).

MethodsA case control study was conducted.A total of 57 patients (64 eyes) with initial diagnosis of ARN not accompanied by RD were enrolled in Qingdao Eye Hospital of Shandong First Medical University from March 2013 to April 2021.Among them, 36 cases (40 eyes) were male and 21 cases (24 eyes) were female, with an average age of (51.72±9.73) years.All patients received topical ophthalmic, systemic intravenous and oral antiviral and anti-inflammatory medications, as well as intravitreal injection of ganciclovir according to the patient's condition and willingness.The RD group was divided into RD group and RD-free group according to whether RD occurred during the 1-year follow-up, of which 23 cases and 23 eyes (35.94%) in the RD group occurred from 27 to 160 days after the onset of the disease, with a mean of 45(30, 83) days.The degree of anterior chamber inflammation was evaluated and graded.The scope of retinal necrosis was evaluated by nine-directional fundus color photographs or ultra-wide angle laser scanning ophthalmoscopy without pupil dilation combined with fundus fluorescein angiography.Retinal hemorrhage was divided into three types, no or little scattered patchy hemorrhage, patchy retinal hemorrhage with >1 papillary diameter (PD) and frost-branch retinal hemorrhage.Baseline systemic parameters included sex, age, course of disease, etc.Ocular parameters included best corrected visual acuity, intraocular pressure, anterior segment inflammatory response, retinal hemorrhage, as well as invasion degree and scope of retinal necrosis.Therapy parameters included duration of systemic antiviral drug treatment, with or without intravitreal injection of ganciclovir and the injection frequency as independent variables, and RD occurred whether or not as dependent variables for multivariate logistic regression analysis.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Qingdao Eye Hospital (No.2020-15).

ResultsFour eyes with severe vitreous opacity were excluded.In the fundus image analysis of the other 60 eyes, the necrotic lesion involved retina reaching 1 to 4 quadrants were in 14, 9, 17 and 20 eyes, respectively.Necrotic lesion affected 13, 23 and 24 eyes in zone 3, zone 2 and zone 1, respectively.Before treatment, frost-like retinal hemorrhage occurred in 26 eyes (43.33%), retinal hemorrhage with >1 PD in 25 eyes (41.67%). Compared with RD-free group, the RD group had a longer course of disease, worse baseline visual acuity, larger necrotic lesions, more eyes with more invasion areas close to the macular area, and more eyes with frost-branch retinal hemorrhage, with statistically significant differences (all at P <0.05). There were no significant differences in age, intraocular pressure, anterior segment inflammatory response, duration of intravenous antiviral drug injection, with or without intrvitreal injection of antiviral drug and injection frequency between the two groups (all at P>0.05). Multivariate logistic regression analysis showed that the occurrence of frost branch-retinal hemorrhage was a high risk factor for RD (odds ratio=9.14, 95% confidence interval: 1.10-82.44, P=0.049). There were no significant differences between the two groups in age, intraocular pressure, anterior inflammatory response, time of intravenous antiviral drug injection, whether or not antiviral drug was injected into vitreous cavity and frequency at the time of initial diagnosis (all at P>0.05).

ConclusionsFrost-branch retinal hemorrhage is a risk factor for retinal detachment in ARN.