Prophylactic laser photocoagulation for acute retinal necrosis. Does it raise more questions than answers?

Acute retinal necrosis (ARN) is a rare condition1 which can potentially lead to devastating visual outcomes, with one study reporting visual acuity (VA)≤20/200 in 48% eyes at last follow-up.2 Retinal detachment is a major cause of severe visual loss,3^–7 other causes of visual loss are macular damage, optic nerve involvement, cataract and glaucoma.2 4 The retinal breaks occur as result of combination of retinal necrosis and vitreoretinal traction, these breaks can occur posteriorly as well as at the vitreous base.8 The location of most of the retinal breaks are at the junction of diseased and uninvolved retina;6 9 however, they can even occur in areas where retinitis is absent.6 The retinal detachments can occur weeks to months after the onset of inflammation due to delay in the formation of retinal breaks.8 Rhegmatogenous retinal detachment and proliferative vitreoretinopathy will occur in up to 85% of ARN cases3 6 10 11 and is associated with poor visual prognosis.3^–7 10

The anatomical success rate from retinal detachment surgery in ARN has been reported at 22% to 94%.3 5 6 Comorbidity associated with ARN such as optic nerve involvement and/or photoreceptor damage limits final visual results despite anatomical success.2 3 Blumenkranz and co-workers5 found that in their series of 16 patients with retinal detachment secondary to ARN, eight patients had a final visual acuity of less than or equal to 20/200 despite having a final retinal reattachment …