Clinical Features and Outcomes in Patients with Acute Retinal Necrosis in Both Eyes at the Time of Initial Presentation – Bilateral Acute Retinal Necrosis (BARN)

PURPOSE: To analyze the clinical features and outcomes in patients presenting with Bilateral Acute Retinal Necrosis (BARN) at the time of initial presentation. METHODS: Retrospective, observational study of patients with bilateral Acute Retinal Necrosis (BARN) at a tertiary care center in South India from 2016 to 2025. Data collected included demographics, systemic and ocular history, BCVA (converted to logMAR for analysis), treatment modalities (medical and surgical), and complications such as retinal detachment, glaucoma, and phthisis bulbi. RESULTS: BARN was noted in 41 patients out of a total of 319 clinical records of ARN (12.8%). One-third patients (36.5%) had a history of HIV. The mean BCVA improved from 1.37 logMAR at presentation to 1.18 logMAR after a mean follow-up of 38.4 months. Rhegmatogenous retinal detachment (RRD) was the most common complication, affecting 36.5% (30/82) of eyes, with 8 eyes presenting with RRD and 22 developing it during follow-up. Exudative retinal detachment was noted in 7 eyes. Other complications included optic atrophy (10.9%), phthisis bulbi (4.8%), glaucoma (2.4%), and epiretinal membrane (1.2%). Medical treatment included antivirals and systemic corticosteroids. CONCLUSION: Bilateral acute retinal necrosis is uncommon but has more severe course and results in significant ocular complications and poor visual outcomes underscoring the aggressive nature of the disease.