The case of a patient with acute herpes-associated retinal necrosis

BACKGROUND: Acute retinal necrosis is a serious uveal syndrome of viral origin, which manifests with inflammatory reaction in the vitreous body and in the anterior chamber of the eye, along with the rapidly progressing peripheral necrotic retinitis and occlusive vasculitis. This condition is complicated by retinal detachment in 65–75% of the cases, which may lead to the complete loss of vision. The prognosis for the patients with acute retinal necrosis is generally unfavorable: in case of late diagnostics and insufficient treatment, there is a risk of irreversible blindness, while in 60% of the cases, a decrease in the visual functions below 0.1 is observed. CLINICAL CASE DESCRIPTION: The female patient М., aged 57 years, in 2023 was admitted with the complaints of decreased vision acuity and photophobia in her right eye developing 2 months after a previous episode of acute respiratory viral infection. Physical examination data for the right eye (OD): best corrected visual acuity 0.2, intraocular pressure 29 mm.Hg., the anterior-posterior size is 23.06 mm; according to the biomicroscopy data — pericorneal injection of the conjunctiva and variously sized white-colored precipitates along the whole corneal endothelium. 3 weeks after the initial treatment, the patient had retinal detachment with a decrease in visual acuity to light perception with proper light projection. After the conducted conservative and surgical ophthalmological treatment, including the treatment prescribed by the Infectious Disease Physician, from the beginning of 2024 and to the present day, the periodical control examinations reveal the best corrected visual acuity of 0.1–0.2 in the right eye (OD) of the patient. The intraocular pressure is 15–16 mm.Hg, the anterior-posterior size in 2025 became equal to 21.63 mm. The field of vision has changed insignificantly, without any clear negative changes. Ophthalmoscopically and according to the data from the optical coherence tomography, there is a persisting cystous intraretinal edema, tangential-traction syndrome and pre-retinal membrane in the right eye with no negative changes; the retina is attached in all the meridians. CONCLUSION: This case underlines the importance of the combined and multidisciplinary approach to the diagnostics and treatment of ophthalmological diseases caused by viral infections.