Refractory acute retinal necrosis presenting as peripapillary choroiditis - A diagnostic and therapeutic challenge

Indian J Ophthalmol. 2025 Jan 1;73(Suppl 1):S2-S6. doi: 10.4103/IJO.IJO_894_24. Epub 2024 Aug 14.

Abstract

This report describes a challenging case of refractory acute retinal necrosis (ARN) with peripapillary choroiditis as the initial presenting sign. Imaging studies confirmed multifocal choroidal lesions and noted the novel sign of vertical hyper-reflective strips (VHRS) in the outer nuclear layer. Initial treatment with acyclovir and valacyclovir failed, and involvement of the other eye suggested a resistant variant of varicella zoster virus. High-dose oral famciclovir therapy resulted in rapid resolution of ARN in both eyes. This case highlights the rare occurrence of choroiditis, the novel finding of VHRS, and the potential utility of high-dose oral famciclovir in treating refractory ARN.

Publication types

  • Case Reports

MeSH terms

  • Administration, Oral
  • Antiviral Agents* / therapeutic use
  • Choroiditis* / diagnosis
  • Choroiditis* / drug therapy
  • Diagnosis, Differential
  • Eye Infections, Viral* / diagnosis
  • Eye Infections, Viral* / drug therapy
  • Eye Infections, Viral* / virology
  • Famciclovir
  • Fluorescein Angiography / methods
  • Fundus Oculi
  • Herpes Zoster Ophthalmicus / diagnosis
  • Herpes Zoster Ophthalmicus / drug therapy
  • Herpes Zoster Ophthalmicus / virology
  • Herpesvirus 3, Human / genetics
  • Herpesvirus 3, Human / isolation & purification
  • Humans
  • Optic Disk / pathology
  • Retinal Necrosis Syndrome, Acute* / diagnosis
  • Retinal Necrosis Syndrome, Acute* / drug therapy
  • Retinal Necrosis Syndrome, Acute* / virology
  • Tomography, Optical Coherence / methods
  • Visual Acuity

Substances

  • Antiviral Agents
  • Famciclovir