Vitrectomy for a case of acute retinal necrosis progressing to severe retinal necrosis

Background: We report a case of severe acute retinal necrosis that progressed to total retinal detachment due to misdiagnosis. Case Report: The patient, a 75-year-old female with a diagnosis of "sarcoidosis", had been treated with steroid pulse therapy. She later presented with marked decreased vision with total retinal detachment due to multiple retinal breaks and was referred to the Department of Ophthalmology, Osaka Medical College. At the time of admission, the patient had visual acuity of light perception, cells in the anterior chamber, and total retinal detachment with multiple breaks ("used mop" appearance) in her right eye. Lensectomy and vitrectomy were performed. The vitreoretinal adhesions were so strong at the site of retinal necrosis that a bimanual technique was necessary. Postoperatively, the patient's visual acuity remained 0.02 due to the presence of a retinal fold with an epiretinal membrane. Conclusions: Recently, the surgical outcome of vitrectomy for acute retinal necrosis has improved; however, the operation is extremely difficult when the condition has progressed to total retinal detachment (the "used mop" stage). Administering corticosteroid appropriately and performing vitrectomy before the appearance of advanced retinal detachment should be considered to decrease the risk of serious visual loss due to acute retinal necrosis.