Intraocular Fluid Analysis-Guided Precision Therapy in the Treatment of Acute Retinal Necrosis Syndrome

Abstract Objective: To explore the role of intraocular fluid testing in the treatment and prognostic assessment of Acute Retinal Necrosis Syndrome (ARNs), providing a basis for personalized treatment and prognostic evaluation of ARNs. Methods: A total of 46 cases of ARNs patients (49 eyes) treated at the Eye Hospital affiliated with Nanchang University from January 2021 to January 2023 were included in the study. The patients were divided into two groups based on whether they underwent intraocular fluid testing: the intraocular fluid testing-guided treatment group (the precision treatment group) and the conventional treatment group. In the precision treatment group, patients with intraocular fluid viral nucleic acid copy numbers less than 5x10^6 were treated with intravitreal injections of ganciclovir/aciclovir (20mg/ml, 0.1ml) twice a week, while those with copy numbers greater than 5x10^6 were treated with intravitreal injections of ganciclovir/aciclovir (40mg/ml, 0.1ml) twice a week. The conventional treatment group received intravitreal injections of ganciclovir (20mg/ml, 0.1ml) twice a week. Best Corrected Visual Acuity (BCVA) was recorded before treatment and at 12 months post-treatment. The precision treatment group also had to record the pre-treatment intraocular fluid levels of viral copy numbers, interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), vascular cell adhesion molecule (VCAM), vascular endothelial growth factor (VEGF), and basic fibroblast growth factor (BFGF). The BCVA at the preoperative and final follow-up visits for both groups were analyzed and compared, and the preoperative parameters were correlated with the final BCVA. Results A total of 22 patients (22 eyes) in the precision treatment group and 24 patients (27 eyes) in the traditional treatment group were included. There were no significant differences in baseline BCVA, intraocular pressure, onset time, age, retinal necrosis foci partition, degree of involvement quadrant count and vitreous opacity between the two groups (P > 0.05), but the number of vitrification in the precision treatment group was lower than that in the traditional treatment group (P < 0.05). The final BCVA of the precision treatment group was significantly higher than that of the traditional treatment group, the difference was statistically significant (t=2.11, P=0.04). The incidence of retinal detachment was 27.3% (6eyes) in the precision treatment group and 59.3% (16 eyes) in the traditional treatment group. There was significant difference between the two groups (x2=5.01, P=0.03). The results of correlation analysis showed that in the precision treatment group, the baseline BCVA was positively correlated with the final BCVA, and the viral copy number was negatively correlated with the final BCVA (r=0.96, -0.50, P<0.001,0.02). Viral copy number was positively correlated with vitrectomy times, IL-6, IL-8, VCAM and BFGF (r=0.58, 0.57, 0.78, 0.52, 0.72; P=0.005, 0.007, <0.001, 0.01, <0.001). The time of onset was positively correlated with IL-10 (r=0.82, P<0.001), the number of vitriol was positively correlated with IL-8 content (r=0.45, P =0.04). In the conventional treatment group, the baseline BCVA was positively correlated with the final BCVA (r=0.79,P <0.001), and the number of vitrectomy was positively correlated with age (r=0.44,P=0.02). Spearman correlation analysis showed that the number of quadrants involved by retinal necrosis was positively correlated with the occurrence of retinal detachment and the extent of retinal necrosis (rs=0.524,0.256, P<0.001,0.035) and the final BCVA was negatively correlated with the extent of retinal necrosis (rs=0.318, P=0.008). The extent of retinal necrosis was negatively correlated with the occurrence of retinal detachment (rs=-0.541, P<0.001). In the precision treatment group, the extent of retinal necrosis was positively correlated with the initial BCVA and the final BCVA (rs=0.567,0.537, P=0.006, 0.010), and negatively correlated with IL-6, IL-8 and viral nucleic acid count (rs=-0.436, -0.465, -0.542, P=0.043, 0.029, 0.009). Conclusion Intraocular fluid testing not only provides a more accurate basis for the formulation of individualized treatment plans for patients with ARNs, but also can improve the therapeutic outcomes and assess the prognosis of the patients.