Report 2: Macular edema after acute retinal necrosis—A difficult crossroad in management

PURPOSE: To evaluate cases of acute retinal necrosis (ARN) with macular edema (ME) and review the literature on management strategies for ME in ARN. METHODS: A retrospective analysis was conducted on ME cases secondary to ARN from a cohort of 119 patients with ARN, treated at a tertiary eye care center between 2010 and 2022. Patients with a minimum follow-up of 6 months were included, while those with underlying immunosuppressive disease (e.g. HIV infection) or receiving immunosuppressive therapy or with incomplete documentation were excluded. RESULTS: ME developed in 9.7% of ARN patients among the cohort of 119 patients. The mean age was 41.3 ± 12.3 years (range: 10-60 years), and ten (83.3%) were male. All patients received systemic antiviral therapy and oral corticosteroids. Of 12 affected eyes, eight underwent pars plana vitrectomy with silicone oil tamponade for retinal detachment, and one underwent cataract surgery before ME onset. Following ME development, nine eyes received topical steroids and eight were started on topical NSAIDs, while oral corticosteroids were initiated in all cases. Antiviral prophylaxis was reinitiated in five eyes. Periocular triamcinolone injection was given in one eye, and intravitreal dexamethasone implant was administered thrice in another patient. The median central foveal thickness at diagnosis was 437 µm (range: 342-1284 µm), reducing to 374.5 µm (range: 254-1056 µm) after treatment. CONCLUSION: ME is a rare but visually disabling complication of ARN. Its management remains challenging, and the role of local steroid therapy warrants further evaluation.