Year: 2026
Type: article
Abstract: Purpose of Review: This review aims to provide a comprehensive comparison between acute retinal necrosis (ARN) and progressive outer retinal necrosis (PORN), two sight-threatening manifestations of herpetic viral retinopathies emphasizing how immune status shapes presentation, diagnosis, management, and prognosis. Recent Findings: Recent studies suggest that ARN and PORN represent a spectrum influenced largely by host immune status rather than distinct diseases. Ultra-widefield imaging improves detection of far-peripheral lesions, while PCR of aqueous or vitreous enables rapid etiologic confirmation. In ARN, high-bioavailability oral antivirals, often with adjunct intravitreal injections, accelerate lesion regression and reduce fellow-eye involvement. In PORN, monotherapy performs poorly; combined intensive intravitreal and systemic therapy improves local control but vision remains limited in advanced immunosuppression. Summary: Prompt differentiation based on inflammatory signs, lesion morphology, and host immunity directs therapy. ARN generally responds to systemic agents yet carries substantial detachment risk; PORN progresses quickly with worse outcomes despite aggressive care. Early diagnosis coordinated medical-surgical management, and close surveillance are critical; priorities include optimal dosing and duration of antiviral therapies as well as adjunctive anti-inflammatory strategies.
Source: Current Ophthalmology Reports
Authors: Kisha Kalra, Piero Carletti, Raquel Goldhardt
Institution: University of Miami
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,190
Funder: National Institutes of Health
OpenAlex ID: W7144329673