Retinal Detachment Following Acute Retinal Necrosis and the Efficacies of Different Interventions: A Systematic Review and Meta-Analysis.

PURPOSE To estimate the rate of retinal detachment (RD) following acute retinal necrosis (ARN) and evaluate the efficacies of different interventions. METHODS The databases Medline and EMBASE from inception to March 2020 were searched to identify the relevant studies. R software version 3.6.3 was used to perform the statistical analyses. Results in proportion with 95% confidence interval were calculated using generalized linear mixed models. RESULTS 67 studies involving 1811 patients were finally included. The pooling results suggested the general RD rate of ARN was 47%. The RD rate increased with the extent of retinitis and was slightly lower when involved Zone III. The RD rate was 37% for HSV-ARN and 46% for VZV-ARN; 52% for immunocompetent patients and 39% for immunocompromised patients. RD presented in 2% of eyes at the first visit. Systemic antiviral therapy could lower the RD rate significantly from 67% to 43%, and prophylactic vitrectomy could lower the RD rate significantly from 45% to 22%. Systemic antiviral therapy plus vitrectomy achieved the lowest RD rate to 18%. While the efficacy of prophylactic laser or intravitreal antiviral therapy (IVT) was still limited. Prophylactic vitrectomy might significantly increase the incidence of proliferative retinopathy (PVR) from 7% to 32%. CONCLUSION About half of the eyes might develop RD during the entire course of ARN. Systemic antiviral therapy and prophylactic vitrectomy are effective interventions to prevent RD, whereas the roles of prophylactic laser or adjunctive IVT are still unclear. VZV-ARN and cases with extensive retinitis might need intensified interventions.