Intraocular fluid analysis-guided precision therapy in the treatment of acute retinal necrosis syndrome

Investigate intraocular fluid testing's role in ARNs management and prognosis. 46 ARNs patients (49 eyes) treated from 2021 to 2023 were divided into precision (n = 22) and conventional (n = 24) groups based on intraocular fluid testing. Precision group received intravitreal ganciclovir (20 mg/ml [viral copies < 5 × 10⁶] or 40 mg/ml [> 5 × 10⁶]) twice weekly; conventional group received fixed 20 mg/ml. BCVA, viral copies, cytokines (IL-6, IL-8, IL-10), and biomarkers (VCAM, VEGF, BFGF) were analyzed. No baseline differences in BCVA, IOP, or clinical features between groups (P > 0.05). Precision group showed fewer injections, higher final BCVA, and lower retinal detachment rates (P < 0.05). Viral copies negatively correlated with final BCVA (P < 0.05). In precision group: viral copies positively correlated with injection frequency, IL-6, IL-8, VCAM, BFGF; retinal necrosis extent positively linked to initial/final BCVA but inversely with IL-6, IL-8, and viral load. Conventional group showed retinal necrosis involvement positively correlated with detachment risk (P < 0.05). Intraocular fluid testing optimizes ARNs treatment personalization, improves outcomes, and enhances prognostic evaluation.