Timing of Prophylactic and Early Vitrectomy for First-Presenting or Recurrent Acute Retinal Necrosis Syndrome

Acute retinal necrosis syndrome (ARNS) is a herpetic infectious eye disease that presents clinicians with difficult decisions to make about the indication and timing of surgical intervention. Here I report 2 patients who underwent prophylactic and early vitrectomy with good visual outcomes. Case 1, a 72-year-old man, had a second recurrence of ARNS in the left eye in 2011 and underwent early vitrectomy in the acute inflammatory phase to remove previously formed vitreous opacity and vitreoretinal adhesions, in parallel with intravenous acyclovir and oral prednisolone administration. He had experienced ARNS in the right eye in 1983, in the left eye in 1986, and a recurrence in the left eye in 1999. Case 2, a 66-year-old woman, developed ARNS in the right eye. All of the circumferential retinal lesions became degenerative with intravenous acyclovir and prednisolone. She underwent a vitrectomy in the post-inflammatory phase, since epiretinal proliferation was noted through vitreous opacity with complete posterior vitreous detachment. These cases suggest that early vitrectomy in the acute inflammatory phase would be indicated for pre-existing vitreoretinal adhesions, while prophylactic vitrectomy in the post-inflammatory phase would be indicated for epiretinal proliferation.