{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:54:37Z","timestamp":1791381277449,"version":"4.3.3"},"reference-count":24,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,9,22]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:p>A female patient in her 60s presented with a right eye hypertensive uveitis and subsequently developed vitritis and retinitis. An anterior chamber tap was PCR positive for herpes simplex virus. Despite oral valaciclovir 2\u2009g three times a day and an initial intravitreal foscarnet 2.4\u2009mg\/0.1\u2009mL injection her condition worsened, with more extensive retinal necrosis and retinal haemorrhages. A repeat anterior chamber tap was performed and PCR testing confirmed viral strains resistant to aciclovir. The patient was therefore treated with repeated intravitreal injections of foscarnet along with intravenous foscarnet which stabilised her clinical condition for a time, though unfortunately her retina later detached. Acute retinal necrosis is an uncommon but visually devastating infectious uveitis; in situations where initial antiviral treatments are not stabilising or improving the clinical picture it is important to consider the rare possibility of antiviral resistance. Intravenous foscarnet carries the risks of unpleasant and potentially dangerous side effects, about which patients must be counselled.<\/jats:p>","DOI":"10.1136\/bcr-2026-273344","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:15:27Z","timestamp":1791378927000},"page":"e273344","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Acute retinal necrosis refractory to treatment"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2542-7329","authenticated-orcid":false,"given":"Ian R","family":"Reekie","sequence":"first","affiliation":[{"name":"Ophthalmology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jekaterina","family":"Sidhom","sequence":"additional","affiliation":[{"name":"Ophthalmology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randhir","family":"Chavan","sequence":"additional","affiliation":[{"name":"Ophthalmology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"2026100706152097000_19.10.e273344.1","first-page":"607","article-title":"Unilateral acute uveitis with periarteritis and detachment","volume":"25","author":"Urayama","year":"1971","journal-title":"Jpn J Clin Ophthalmol"},{"key":"2026100706152097000_19.10.e273344.2","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.62.9.581"},{"key":"2026100706152097000_19.10.e273344.3","doi-asserted-by":"crossref","DOI":"10.3390\/diagnostics12020386","article-title":"Acute Retinal Necrosis: Signs, Treatment, Complications and Outcome","volume":"12","author":"Mayer","year":"2022","journal-title":"Diagnostics (Basel)"},{"key":"2026100706152097000_19.10.e273344.4","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.2007.114884"},{"key":"2026100706152097000_19.10.e273344.5","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1038\/eye.2011.338","article-title":"Acute retinal necrosis in the United Kingdom: results of a prospective surveillance study","volume":"26","author":"Cochrane","year":"2012","journal-title":"Eye (Lond)"},{"key":"2026100706152097000_19.10.e273344.6","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1080\/09273948.2025.2464717","article-title":"Acute Retinal Necrosis: A Multicenter Study on Factors Associated with Visual Outcomes and Retinal Detachment","volume":"33","author":"Soitong","year":"2025","journal-title":"Ocul Immunol Inflamm"},{"key":"2026100706152097000_19.10.e273344.7","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.ajo.2017.05.006","article-title":"Acute Retinal Necrosis: Presenting Characteristics and Clinical Outcomes in a Cohort of Polymerase Chain Reaction-Positive Patients","volume":"179","author":"Butler","year":"2017","journal-title":"Am J Ophthalmol"},{"key":"2026100706152097000_19.10.e273344.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2005.03.057"},{"key":"2026100706152097000_19.10.e273344.9","doi-asserted-by":"crossref","first-page":"1816","DOI":"10.1038\/s41433-024-03028-x","article-title":"Diagnostic and therapeutic challenges in acute retinal necrosis; an update","volume":"38","author":"Kalogeropoulos","year":"2024","journal-title":"Eye (Lond)"},{"key":"2026100706152097000_19.10.e273344.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2006.08.037"},{"key":"2026100706152097000_19.10.e273344.11","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(01)00556-5"},{"key":"2026100706152097000_19.10.e273344.12","doi-asserted-by":"crossref","unstructured":"Mahajan S , Saxena RK , Agarwal M . 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