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Four cases of bilateral acute retinal necrosis with a long interval after the initial onset
  1. Yoko Okunuki,
  2. Yoshihiko Usui,
  3. Takeshi Kezuka,
  4. Masaru Takeuchi,
  5. Hiroshi Goto
  1. Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
  1. Correspondence to Yoko Okunuki, Department of Ophthalmology, Tokyo Medical University, 6-7-1 Nishishinjyuku, Shinjyuku-ku, Tokyo 160-0023, Japan; yoko-okunuki{at}


Aims To report the clinical features and causative virus of bilateral acute retinal necrosis (BARN) with a long interval after the initial onset.

Methods The causative virus and clinical features were retrospectively investigated in four patients with delayed-onset BARN with an interval of more than 3 years after the onset of the disease in the initially affected eye.

Results The intervals between the initially affected eye and the latter affected eye of the four cases were 8 years 7 months, 19 years 3 months, 9 years 7 months and 3 years 6 months. The fourth patient developed a second recurrence in the latter affected eye 17 years 6 months after the initial inflammation in the fellow eye. In all four cases, the same virus species, either varicella-zoster virus or herpes simplex virus, was detected in both eyes by PCR or antibody detection. In all cases, the final best-corrected visual acuity of the latter affected eye (20/20, 18/20, 20/20 and 12/20, respectively) was better than that of the initially affected eye (20 cm hand motion, light perception-negative, light perception-negative and light perception-positive, respectively).

Conclusion The present findings indicate that delayed-onset BARN in the fellow eye was caused by the same herpes virus species that induced the disease in the first affected eye.

  • Acute retinal necrosis
  • varicella-zoster virus
  • herpes simplex virus
  • retina
  • immunology
  • infection

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  • Funding None.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Ethics Committee in Tokyo Medical University Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.