Duration 5min, Q&A 3min
Development and Validation of New Diagnostic Criteria for Acute Retinal Necrosis
To develop and validate new diagnostic criteria for acute retinal necrosis (ARN) based on ocular findings, clinical course, and virological testing of intraocular fluids.
This retrospective study analyzed data from 46 patients with ARN and 409 control patients being followed at 7 tertiary uveitis clinics between 2009 and 2011. Control patients had either posterior uveitis or panuveitis that had been diagnosed as cytomegalovirus retinitis, ocular toxoplasmosis, sarcoidosis, Behcet's disease, ocular tuberculosis, syphilitic uveitis, or intraocular lymphoma.
New diagnostic criteria were developed based on combinations of various clinical features consistent with ARN including 6 ocular findings, 5 clinical courses, and the results of virological testing of intraocular fluids. The ocular findings consisted of (1a) anterior chamber cells or mutton-fat keratic precipitates, (1b) white-yellow lesion(s) in the peripheral retina, (1c) retinal arteritis, (1d) inflammatory vitreous opacities, and (1e) elevated intraocular pressure. The clinical courses consisted of (2a) rapid progression of retinal lesion(s) circumferentially, (2b) development of retinal break or retinal detachment, (2c) retinal vascular occlusion, (2d) optic atrophy, and (2e) response to antiviral agents. Virological testing of intraocular fluids consisted of analysis by either polymerase chain reaction or Goldmann-Witmer coefficient for herpes simplex virus or varicella zoster virus. Various combinations of these clinical features were analyzed in order to maximize the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) using the new diagnostic criteria.
Results and Conclusion
Analysis of data allowed delineation of 2 levels of diagnosis, "definite" and "probable". A "definite" diagnosis was defined as being the presence of ocular findings 1a and 1b, the presence of any 1 of 5 clinical courses, and a positive virological test result. A "probable" diagnosis was defined as being the presence of 4 of 6 ocular findings including 1a and 1b, presence of any 2 of 5 clinical courses, and a negative virological test result or when virological testing had not been performed. Using these criteria for "definite" and "probable" diagnoses on 46 patients with ARN and 409 patients with control uveitis, the sensitivity was found to be 0.89, the specificity 1.00, the PPV 1.00, and the NPV 0.99.
In conclusion, new diagnostic criteria for "definite" and "probable" ARN were developed and found to achieve high statistical value. A nationwide survey had been initiated in Japan in order to further validate these diagnostic criteria.
[ Keyword ]
Acute retina necrosis / Uveitis / Diagnostic criteria / Polymerase chain reaction
[ Conflict of Interest ]