J Korean Ophthalmol Soc > Volume 56(3); 2015 > Article
Journal of the Korean Ophthalmological Society 2015;56(3):452-457.
DOI: https://doi.org/10.3341/jkos.2015.56.3.452    Published online March 15, 2015.
A Case of Atypical Acute Retinal Necrosis Observed Using Ultra-Wide-Field Imaging.
Hyung Woo Lee, Hyung Chan Kim
Department of Ophthalmology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea. eyekim@kuh.ac.kr
광각안저촬영으로 관찰한 비정형 급성망막괴사
이형우⋅김형찬
건국대학교 의학전문대학원 건국대학교병원 안과학교실
Abstract
PURPOSE
To Report A Case Of Atypical Acute Retinal Necrosis (Arn) Observed Using Ultra-wide-field Imaging. CASE SUMMARY: A 50-year-old male with recurrent oral ulcer presented with visual loss in his right eye. On the initial visit, slit-lamp examination showed inflammatory cells (3+) in the anterior chamber and vitreous of the right eye. Funduscopic examination and ultra-wide-field fundus images showed severe occlusive vasculitis with perivascular hemorrhage. No necrotic lesion was observed at the peripheral retina in the left eye. Under the impression of Behcet's uveitis, immunosuppressive therapies including oral steroid, intravenous cyclophosphamide, anti-tumor necrosis factor (TNF) alpha agent and intravitreal triamcinolone were administered, but without improvement. Subsequently, a necrotic lesion appeared at the far peripheral retina in the right eye and varicella-zoster virus was identified using the polymerase chain reaction test. After the patient was diagnosed with atypical ARN, intravenous acyclovir was administered, resulting in eventual suppression of the necrotic lesion progression. Due to retinal detachment, pars plana vitrectomy with silicone oil infusion was performed in the right eye. At that time, a whitish lesion at the far peripheral retina in the ultra-wide-field photography of the fellow eye was found and 3 intravitreal ganciclovir injections were administered. Finally, the whitish lesion regressed after 1 month. CONCLUSIONS: Ultra-wide-field imaging might be useful for diagnosis and follow-up of atypical ARN patients.
Key Words: Acute retinal necrosis;Behcet's uveitis;Polymerase chain reaction;Ultra-wide-field imaging


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