A Comparison between Prophylactic Vitrectomy and Laser Photocoagulation in Treatment of Acute Retinal Necrosis Syndrome

Purpose: To compare the results of prophylactic pars plana vitrectomy with barrier laser photocoagulation in treatment of acute retinal necrosis (ARN). Patients and Methods: Fifteen ARN patients were retrospectively included in this study. At presentation, all patients had severe vitreous involvement without any detectable break or retinal detachment (RD), either in funduscopy or echography exams. All patients received intravenous acyclovir 2 g/daily for two weeks. Eight patients underwent prophylactic vitrectomy and seven patients underwent barrier laser photocoagulation after resolution of vitritis. Visual and structural outcomes were compared between the two groups. Results: In eight vitrectomized patients, one patient (12.5 %) experienced RD. The mean best corrected visual acuity (BCVA) improved significantly in this group (P = 0.027). Among seven patients undergoing barrier laser photocoagulation, 3 patients (43 %) developed RD and BCVA improvement was not significant (P = 0.207). Comparison between the two groups did not show any statistically significant benefit when comparing post treatment BCVA (P = 0.59) or RD prevention (P = 0.282). Conclusion: Early prophylactic vitrectomy, in the course of ARN has been suggested as a useful method in preventing RD and improving the visual outcome, but the results of the present study did not indicate any significant benefit for vitrectomy compared to barrier laser photocoagulation. Further studies with larger sample size are recommended to compare these two methods of treatment.