Acute Retinal Necrosis: Diagnostic and Treatment Strategies in Germany

Abstract

Purpose: To analyze the preferred practice respective diagnosis, treatment, and complications in patients with acute retinal necrosis in Germany.

Methods: The uveitis-section of the German Ophthalmologic Society developed a questionnaire with 12 questions concerning patients with acute retinal necrosis seen in the 5 years up to August 2009.

Results: In total, 35 eye hospitals answered the questionnaire and reported 213 patients with acute retinal necrosis. Diagnosis was made clinically in 86%. Anterior chamber tap, vitreous biopsy, diagnostic vitrectomy, and serology were performed for confirmation. Therapy was started with acyclovir in all institutions, and continued with ganciclovir, foscarnet and brivudine in some cases. Intravitreal injections were performed in 46%. Additional oral steroids were given in 80%. A following oral antiviral treatment was performed in 94%.

Conclusions: Relevant variations were seen in diagnosis and treatment practices. The survey outlines the need for a unique diagnostic and therapeutic guideline.

Keywords:

• Acute retinal necrosis
• anterior chamber tap
• diagnostic vitrectomy
• intravitreal injection
• uveitis

Acknowledgments

We thank all the ophthalmologists throughout Germany who took time and effort to fill out the questionnaires: Professor Engelmann, Hospital Chemnitz; Professor Pillunat, University Hospital, Dresden; Professor Lohmann, Eye Hospital at the right side of the Isar, Munich; Professor Wiechens, Eye Hospital, Hannover; Dr Kaskel-Paul, Hospital Lüdenscheid; Dr Werschnik, Helios Hospital, Schwerin; Dr Schäfer, Hospital Eberswalde; Dr Wondwossen, Hospital Dresden; Professor Hörauf, University Hospital, Göttingen; Professor Heiligenhaus, St Franziskus Hospital, Münster, University of Duisburg, Essen; Professor Wiegand, Asklepios Hospital, Hamburg; Professor Kirchhoff, University Hospital, Köln; Professor Koch, University Hospital, Frankfurt; Professor Walter, University Hospital, Aachen; PD Dr Deuter, University Hospital, Tübingen; Professor Joussen, formerly University Hospital Düsseldorf, now University Hospital Charite; University of Medicine, Berlin; Eye Hospital Suhl; Professor Thurau, University Hospital, Munich; Dr Osterholz, St Joseph Hospital, Bremen; Dr Zurdel, Hospital Stuttgart; Dr Ungerechts, Hospital Darmstadt; Professor El-Shabrawi, Hospital Klagenfurt, Austria; Professor Walter, University Hospital Homburg/Saar; Dr Reuber, Eye Practice, Nürnberg; Professor Becker, Eye Hospital, Zürich, Switzerland; PD Dr Mackensen, University Hospital, Heidelberg; Dr Ehrich, Helios Hospital, Plauen; Professor Garweg, Lindenspital, Bern; Professor Eter, formerly University Hospital Bonn, now University Hospital, Münster and Professor Löffler, University Hospital, Bonn; Professor Hillenkamp, formerly University Hospital Kiel, now University Hospital, Würzburg; Dr Nölle, University Hospital, Kiel; Professor Mennel, University Hospital, Marburg; PD Dr Schönfeld, Eye Hospital Herzog Carl Theodor, Munich; Professor Bornfeld and Dr Kadir, University Hospital, Essen; Professor Pleyer, Campus Virchow-Klinikum, Charité, University of Medicine, Berlin; PD Dr Ness, University Hospital, Freiburg.

Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Notes

The content of this paper was presented at the World Ophthalmology Congress (WOC) 2010 in Berlin.