Background and objective <p> To investigate whether patients diagnosed with acute retinal necrosis (ARN) previously treated with combination systemic and intravitreal antiviral injection have better long-term outcomes than those treated with systemic antiviral monotherapy</p> Patients and methods <p>Follow-up retrospective cohort study analyzing data collected since 2009.¹ Patient medical charts were reviewed for ophthalmologic data.</p> Results <p>Of the original 24 patients, eight patients (nine eyes) had sufficient data for analysis. Six eyes had previously received combination systemic and intravitreal antiviral therapy, and three eyes were treated with systemic monotherapy (<i>P</i> = 0.39). Average follow-up was 177 months. Within each group, no significant difference was detected between initial and final logMAR VA (i.e. combination therapy: <i>P</i> = 0.78; systemic monotherapy: <i>P</i> = 0.60). There was no significant difference in the development of phthisis or enucleation between treatment groups.</p> Conclusion <p>In this long-term cohort of ARN patients, two-thirds of patients in the original study were lost to follow-up leading to reduced sample size, however the loss was equal between the two groups. Given our limited sample size available for follow-up, there is no definitive recommendation for changing the current paradigm of treatment for this disease. Our data suggests that long-term follow-up is required for patients with ARN following their initial treatment. We recommend further studies to provide definitive recommendations in this complex patient group.</p>