Table_1_Acute Retinal Necrosis: Clinical Features, Diagnostic Pitfalls, Treatment, and Outcome of an Insidious Disease in Children. Case Report and Review of the Literature.XLSX

ObjectiveThis study aims to explore clinical features, diagnostic work-up, treatment, and outcomes of pediatric patients with acute retinal necrosis (ARN), and to propose a standardized management of this condition in childhood.
MethodsClinical manifestations, diagnostic work-up, and treatment of three pediatric cases with ARN were analyzed. Furthermore, a review of the literature was performed from January 1990 to November 2021, focused on 1) clinical presentation; 2) differential diagnosis, including both infectious and non-infectious conditions; 3) key role of diagnostic techniques; and 4) currently available treatments.
ResultsData from 72 children with ARN (69 from literature and 3 from our center) were analyzed. The most frequent presenting symptoms were red eye resistant to topical treatment (57%) and altered vision (58%), 25 patients had bilateral involvement. In 30% a known history of herpetic infection was reported. PCR testing on anterior chamber and/or vitreous sampling was performed in 46 cases (64%) and was diagnostic in 88% of them, with herpes simplex virus (HSV) 2 being the most frequently identified pathogen (57%). All patients underwent systemic antiviral therapy (16% only oral); adjunctive intravitreal injections were performed in 21% of them.
ConclusionsARN is a rare but severe ocular infection presenting as a panuveitis with occlusive retinal vasculitis and peripheral retinal necrosis. Varicella-zoster virus and HSV 1–2 are most frequently implicated. Due to a high incidence of rhegmatogenous retinal detachment and optic atrophy, ARN has a poor prognosis with a potentially severe impact on visual function. Although a prompt recognition is crucial to prevent complications, ARN diagnosis in children is still challenging.

【研究目的】本研究旨在探讨儿科急性视网膜坏死（acute retinal necrosis, ARN）患者的临床特征、诊断流程、治疗方案及预后转归，并提出儿童该疾病的标准化管理策略。
【研究方法】本研究分析了3例儿科ARN患者的临床表现、诊断流程及治疗方案。此外，本研究检索了1990年1月至2021年11月的相关文献，重点关注以下4个方面：1）临床表现；2）鉴别诊断（涵盖感染性与非感染性疾病）；3）诊断技术的核心作用；4）当前可用的治疗手段。
【研究结果】本研究共分析了72例ARN患儿的临床数据（其中69例来自文献报道，3例来自本中心）。最常见的首发症状为局部治疗无效的眼红（57%）及视力下降（58%）；25例患者为双眼受累。30%的患儿既往有疱疹病毒感染史。对46例（64%）患儿的前房及/或玻璃体取样进行聚合酶链反应（polymerase chain reaction, PCR）检测，其中88%的检测结果呈阳性，最常检出的病原体为2型单纯疱疹病毒（herpes simplex virus 2, HSV-2），占比57%。所有患儿均接受了全身抗病毒治疗（其中16%仅接受口服给药）；21%的患儿联合接受了玻璃体内注射治疗。
【研究结论】ARN是一种罕见但病情危重的眼部感染性疾病，临床表现为全葡萄膜炎伴闭塞性视网膜血管炎及周边视网膜坏死。水痘-带状疱疹病毒及1、2型单纯疱疹病毒是最常见的致病病原体。由于该病继发孔源性视网膜脱离及视神经萎缩的发生率较高，ARN患者的预后较差，可对视觉功能造成严重损害。尽管早期识别对于预防并发症至关重要，但儿童ARN的诊断仍颇具挑战。