| Objective:To observe and explore the relationship between clinical features,time selection of vitrectomy and prognosis of acute retinal necrosis syndrome(ARNS).Methods:Approach to retrospective studies,Clinical data of 17 ARNS patients(24 eyes)from the fundus disease department of the Affiliated Eye Hospital of Nanchang University in January 2015 to December 2018 was reviewed.Ophthalmologic examinations,antivirus therapy and glucocorticoid Treatment were given in all patients.8 eyes with retinal detachment at admission were treated by vitrectomy combined with silicone oil;5 eyes in 16 eyes with no retinal detachment were treated by prophylactic vitrectomy combined with silicone oil,The remaining 11 eyes were treated by intravitreal therapy combination systemic and intravitreal antiviral therapy.Follow-up 3-20 month,by comparing the changes of best corrected visual acuity(BCVA)and ocular signs before and after treatment,statistical analysis of prognostic factors of different treatment methods.Result:There were 12 males per 5 females among 17 patient in the study,the average age of all patients was 50.47±16.02-year-old,ranged from 20 to 80-year-old.7 cases with both eyes involved.5 eyes of silicone oil have been taken out in 13 eyes after prophylactic vitrectomy combined with silicone oil,five months after discharge,one case occurred recurrent retinal detachment after silicone oil removal.2 eyes of systemic antiviral therapy combined with prophylactic laser photocoagulation occurred recurrent retinal detachment after discharge for five months.The rest of the retinas were well attached.Before treatment,the mean BCVA of RD group and no RD group were 1.51±0.75,1.19±0.79,last follow-up,the mean BCVA of RD group and no RD group were 1.29±0.76,0.73±0.71.There was no statistically significant difference of RD group before and after treatment in visual acuity(P=0.197),but in the no RD group,visual acuity between before and after treatment was statisticallysignificant difference(P=0.038).The last follow-up BCVA improved by 14eyes(58.3%)compared with admission.There was statistically significant difference in BCVA improvement between RD group and no RD group(P=0.032),and whether necrosis lesions involved posterior retina was statistically significant difference in BCVA improvement(P=0.035).In no RD group,There was no statistically significant difference in BCVA improvement between Drug and surgical treatment(P=0.245).Compared with vitrectomy after retinal detachment,prophylactic vitrectomy in BCVA improvement was statistically significant difference(P=0.021).Conclusion:Early antiviral therapy of ARNS can effectively control the progress of the disease and improve the prognosis visual acuity,if antiviral therapy fails to control the progression of the lesion,such as the aggravation of vitreous opacity,fusion and expansion of retinal necrosis lesions,prophylactic vitrectomy can effectively improve the prognosis of visual acuity and reduce the incidence of retinal detachment.When retinal detachment or necrotic lesions involve the posterior pole,the risk of poor prognosis increases with the prolongation of the course of disease. |
