Acute retinal necrosis presenting exudative retinal detachment: a case report.

Authors

Han Wang, Ying Zhu, Ai Xuan Cheng, Chao Zhang

Published in

Frontiers in medicine. Volume 13. Pages 1746774. Epub Jun 24, 2026.

Abstract

Acute retinal necrosis (ARN) is a severe, rapidly progressive viral retinitis that is commonly complicated by rhegmatogenous retinal detachment in its late stage. However, the presentation of ARN with exudative retinal detachment (ERD) in the early phase is exceptionally rare, particularly when caused by varicella zoster virus (VZV) in an adult patient. This report highlights this atypical presentation, which initially occurred without definite evidence of retinal necrosis, posing a diagnostic challenge.
A 43-year-old woman presented with acute blurred vision, eye redness, and ocular pain in the left eye of 3 days' duration. Initial clinical examination revealed ciliary congestion, vitritis, optic disc swelling, and a non-rhegmatogenous retinal detachment. Optical coherence tomography demonstrated optic disc and macular edema with intraretinal cystic spaces and a serous retinal detachment temporal to the fovea. Given the atypical presentation, the patient was initially treated with corticosteroids. Two days later, characteristic peripheral retinal necrotic lesions appeared, prompting immediate aqueous humor sampling. Metagenomic testing confirmed VZV infection. The patient was then treated aggressively with systemic intravenous acyclovir, intravitreal ganciclovir injections, and systemic corticosteroids. This regimen led to rapid resolution of the retinal detachment and complete resolution of the retinal lesions, with stable visual acuity maintained at 1 month of follow-up.
Exudative retinal detachment is a rare manifestation of early-stage ARN. In uveitis patients presenting with ERD who show a poor response to initial anti-inflammatory therapy, viral infection (particularly VZV) should be considered in the differential diagnosis. Aggressive combined systemic and intravitreal antiviral therapy, alongside corticosteroids, is critical for achieving favorable anatomical and visual outcomes in these challenging cases.

PMID:
42422832
Bibliographic data and abstract were imported from PubMed on 09 Jul 2026.

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