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<p>This study presents a rare and complex case of acute retinal necrosis (ARN) complicated by central retinal artery occlusion (CRAO) following recovery from SARS-CoV-2 infection. Comprehensive analysis of published cases suggests that cardiovascular or cerebrovascular diseases, history of herpes encephalitis or meningitis, and immunocompromised status may be risk factors for CRAO in ARN patients. Misdiagnoses and delayed diagnoses frequently occur in the initial stages, often leading to poor outcomes due to the absence of antiviral therapy or inappropriate corticosteroid use. Early identification and timely antiviral and anticoagulant therapy seem to limit retinal necrosis and prevent arterial occlusion. This study further proposes that SARS-CoV-2 may synergistically reactivate latent herpesviruses and promote thrombogenesis within the central retinal artery (CRA). It induces endothelial injury, elevates inflammation and coagulation activity, and increases intrasheath pressure due to optic nerve inflammation, compressing the CRA. This effect, along with SARS-CoV-2-induced AngII elevation and vasoconstriction, exacerbates hemodynamic changes and coagulopathy in CRA. The study emphasizes the need for dilated eye examinations in all new uveitis patients, with prophylactic antiviral therapy specifically recommended for those with high ARN risk factors following SARS-CoV-2 infection. A multidisciplinary team (MDT) approach, combined with comprehensive antiviral treatment, is crucial for managing these cases, aiming to improve prognosis through urgent interventions for ARN-related CRAO.</p>

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Delayed acute retinal necrosis complicated by central retinal artery occlusion post-SARS-CoV-2 recovery: clinical practice and review

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年2月14日

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  • RunDong Jiang,
  • Dan Lin,
  • Han Feng,
  • WenJuan Chen,
  • AnNa Pan,
  • Xin Wen,
  • YuQin Wang

摘要

This study presents a rare and complex case of acute retinal necrosis (ARN) complicated by central retinal artery occlusion (CRAO) following recovery from SARS-CoV-2 infection. Comprehensive analysis of published cases suggests that cardiovascular or cerebrovascular diseases, history of herpes encephalitis or meningitis, and immunocompromised status may be risk factors for CRAO in ARN patients. Misdiagnoses and delayed diagnoses frequently occur in the initial stages, often leading to poor outcomes due to the absence of antiviral therapy or inappropriate corticosteroid use. Early identification and timely antiviral and anticoagulant therapy seem to limit retinal necrosis and prevent arterial occlusion. This study further proposes that SARS-CoV-2 may synergistically reactivate latent herpesviruses and promote thrombogenesis within the central retinal artery (CRA). It induces endothelial injury, elevates inflammation and coagulation activity, and increases intrasheath pressure due to optic nerve inflammation, compressing the CRA. This effect, along with SARS-CoV-2-induced AngII elevation and vasoconstriction, exacerbates hemodynamic changes and coagulopathy in CRA. The study emphasizes the need for dilated eye examinations in all new uveitis patients, with prophylactic antiviral therapy specifically recommended for those with high ARN risk factors following SARS-CoV-2 infection. A multidisciplinary team (MDT) approach, combined with comprehensive antiviral treatment, is crucial for managing these cases, aiming to improve prognosis through urgent interventions for ARN-related CRAO.