Medical Case Reports

Biography

Biography: Margaret Wong

Abstract

Acute retinal necrosis (ARN) progresses quickly to severe vision loss with delayed diagnosis. This comparison of ARN cases shows one diagnosed early and the other misdiagnosed and treated late. A 42-year-old Caucasian male had a respiratory infection treated with prednisone. Facial shingles developed two weeks later treated with Valtrex. Vision was 20/20 and 20/25, respectively. Right eye was normal. Left eye showed anterior chamber inflammation and retinal necrosis. ARN was diagnosed and treated with Valtrex and Durezol. The disease completely resolved and medications discontinued. Two months later, anterior segment inflammation and cystoid macular edema developed in the left eye. This was treated with Valtrex, Pred Forte and Prolensa. Eye drops were discontinued and Valtrex will continue indefinitely. Patient’s vision remains 20/20 bilaterally. A 40-year-old Caucasian male presented with one week of rapidly decreasing vision in the left eye. He had a history of herpes treated with Valtrex. An outside physician diagnosed optic neuropathy and retinopathy and started prednisone; vision was 20/200. On presentation to our institution, vision was hand motions and ARN diagnosed. Prednisone was discontinued and started Valtrex and Durezol. Two intravitreal ganciclovir injections were given. Vision improved to counting fingers. He later presented with light perception vision due to retinal detachment. This was repaired and vitreous fluid sent for PCR, which was herpes simplex positive. Vision improved to 20/400 and prophylactic Valtrex continued. This highlights devastating visual consequences with delayed diagnosis of ARN. It is important to have a high index of suspicion for early treatment administration to prevent vision loss.