Acute retinal necrosis other imaging findings

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.

Other imaging findings that may be helpful in the diagonsis of acute retinal necrosis include fundus autofluorescence, fluorescein angiography, and optical coherence tomography.

Fundus autofluorescence (FAF) is an imaging technique that examines fluorophores in the neurosensory retina and the retinal pigment epithelium, presenting with the following findings indicative of acute retinal necrosis:^[1]

• Hypoautofluorescence in the retina, in conjunction with hyperfluorescent borders, is indicative of acute retinal necrosis and atrophy of the retinal pigment epithelium.^[2]
  • Posterior extension of the hyperfluorescent borders may be indicative of spreading inflammation and acute retinal necrosis.
  • Hyperfluorescence may also be indicative of reduced ability to block fluorophores into the retina due to damage and degradation.^[3]
• FAF is advantageous to color photos due to the ability to more starkly contrast lesions with unaffected retinal tissue.

Fluorescein angiographic images may indicate acute retinal necrosis by displaying retinal vasculature and potential retinal hemorrhages, as well as white-yellow necrotic lesions.^[4][5]

• Fluorscein angiography can reveal optic nerve head leakage caused by intraocular inflammation from the pathogent responsible for ARN.^[6]
• Imaging may reveal occlusive vasculopathy and periarterial vascular sheathing.

Optical coherence tomography (OCT) imaging may indicate acute retinal necrosis through the following:^[7]

• Reflective inner layers of the retina, indicative of white-yellow necrotic lesions
  • Abnormalities and disorganization in the retinal structure indicative of inflammation
• Retinal exudate
• Diminished thickness of the retina

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