Misdiagnosis Analysis and Literature Review of Acute Retinal Necrosis Syndrome

ZHANG Xiao-lin

doi:10.3969/j.issn.1002-3429.2016.11.018

Abstract：Objective To investigate clinical characteristics, measures of diagnosis and treatment, misdiagnosed rea-sons and prevention measures of acute retinal necrosis syndrome ( ARNS) . Methods Clinical data of 2 misdiagnosed patients with ARNS was retrospectively analyzed, and related literature was reviewed. Results The 2 patients were female, one pa-tient visited a doctor for left eye redness associated by decreased vision for 3 d, ciliary body congestion and positive Tyndall character, and preliminary diagnosis was iridocyclitis, but symptoms were worsening after corresponding treatment for 5 d. Physical examination showed vitreous opacity and retinal vasculitis changes, and three mirror contact lens examination showed that dissolve necrotic lesions in peripheral retina, and then correct diagnosis was ARNS. The other one visited a doctor for left eye redness associated by decreased vision for 2 d, superior branches of temporal artery occlusion, a little sebum deposits be-hind cornea, positive Tyndall character and inflammatory vitreous opacity, and the patient was successively misdiagnosed as having central retinal artery occlusion and whole uveitis, and symptoms were relieved after corresponding treatment;secondary right eye redness associated by decreased vision, small vascular occlusion, retinal vasculitis and peripheral retinal necrosis were found after left eye pathogenesy for 24 d, and fluorescence fundus angiography showed peripheral retinal necrosis focus in left eye, and then ARNS was confirmed combined with clinical feature and left eye history. The 2 patients received treatment such as antiviral and anticoagulant treatment, and were discharged when conditions were improved after confirming diagnosis. No recurrence was found during follow-up for 3 months and 1 year. Conclusion ARNS should be suspected for young-middle age patients with vitreous opacity, optic disc hyperemia, edema, retinal edema, exudation, hemorrhage, retinal vein circuity or with necrosis foci in binocular or monocular pathogenesy, and fundus oculi fluorescein angiography examination should be performed in time to help the diagnosis.