{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T10:28:12Z","timestamp":1786703292050,"version":"build-2736575974"},"reference-count":12,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute retinal necrosis (ARN) is a severe, rapidly progressive viral retinitis that is commonly complicated by rhegmatogenous retinal detachment in its late stage. However, the presentation of ARN with exudative retinal detachment (ERD) in the early phase is exceptionally rare, particularly when caused by varicella zoster virus (VZV) in an adult patient. This report highlights this atypical presentation, which initially occurred without definite evidence of retinal necrosis, posing a diagnostic challenge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 43-year-old woman presented with acute blurred vision, eye redness, and ocular pain in the left eye of 3\u202fdays\u2019 duration. Initial clinical examination revealed ciliary congestion, vitritis, optic disc swelling, and a non-rhegmatogenous retinal detachment. Optical coherence tomography demonstrated optic disc and macular edema with intraretinal cystic spaces and a serous retinal detachment temporal to the fovea. Given the atypical presentation, the patient was initially treated with corticosteroids. Two days later, characteristic peripheral retinal necrotic lesions appeared, prompting immediate aqueous humor sampling. Metagenomic testing confirmed VZV infection. The patient was then treated aggressively with systemic intravenous acyclovir, intravitreal ganciclovir injections, and systemic corticosteroids. This regimen led to rapid resolution of the retinal detachment and complete resolution of the retinal lesions, with stable visual acuity maintained at 1\u202fmonth of follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Exudative retinal detachment is a rare manifestation of early-stage ARN. In uveitis patients presenting with ERD who show a poor response to initial anti-inflammatory therapy, viral infection (particularly VZV) should be considered in the differential diagnosis. Aggressive combined systemic and intravitreal antiviral therapy, alongside corticosteroids, is critical for achieving favorable anatomical and visual outcomes in these challenging cases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1746774","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T04:45:54Z","timestamp":1782276354000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Acute retinal necrosis presenting exudative retinal detachment: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Han","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Liaoning Provincial Key Laboratory of Cornea and Ocular Surface Diseases, Liaoning Provincial Optometry Technology Engineering Center, Dalian Third People\u2019s Hospital Affiliated to Dalian University of Technology","place":["Dalian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Liaoning Provincial Key Laboratory of Cornea and Ocular Surface Diseases, Liaoning Provincial Optometry Technology Engineering Center, Dalian Third People\u2019s Hospital Affiliated to Dalian University of Technology","place":["Dalian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ai Xuan","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Liaoning Provincial Key Laboratory of Cornea and Ocular Surface Diseases, Liaoning Provincial Optometry Technology Engineering Center, Dalian Third People\u2019s Hospital Affiliated to Dalian University of Technology","place":["Dalian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Liaoning Provincial Key Laboratory of Cornea and Ocular Surface Diseases, Liaoning Provincial Optometry Technology Engineering Center, Dalian Third People\u2019s Hospital Affiliated to Dalian University of Technology","place":["Dalian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2513","DOI":"10.3390\/microorganisms12122513","article-title":"A better understanding of the clinical and pathological changes in viral retinitis: steps to improve visual outcomes","volume":"12","author":"Nguyen","year":"2024","journal-title":"Microorganisms"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1031","DOI":"10.1080\/09273948.2024.2444512","article-title":"An unusual case of exudative retinal detachment in a 6-year-old child with acute retinal necrosis","volume":"33","author":"Kene","year":"2024","journal-title":"Ocul Immunol Inflamm"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1186\/s40942-022-00417-w","article-title":"Acute retinal necrosis. Management and visual outcomes: a case series","volume":"8","author":"Mojarrad","year":"2022","journal-title":"Int J Retina Vitreous"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1961","DOI":"10.1177\/1120672120936181","article-title":"Acute retinal necrosis: clinical manifestation and long-term visual outcomes in a series of polymerase chain reaction-positive patients","volume":"31","author":"Hedayatfar","year":"2021","journal-title":"Eur J Ophthalmol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1038\/s41433-025-03626-3","article-title":"Evolution of annular exudative retinal detachment in acute retinal necrosis: OCT characteristics","author":"Trevi\u00f1o Herrera","year":"2025","journal-title":"Eye (Lond)"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1638","DOI":"10.1016\/S0161-6420(90)32356-4","article-title":"Rapidly progressive acute retinal necrosis secondary to herpes simplex virus, type 1","volume":"97","author":"Duker","year":"1990","journal-title":"Ophthalmology"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1097\/00006982-200108000-00008","article-title":"Acute retinal necrosis in children caused by herpes simplex virus","volume":"21","author":"Tan","year":"2001","journal-title":"Retina"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"499","DOI":"10.3928\/23258160-20150422-18","article-title":"Acute retinal necrosis secondary to herpes simplex virus type 2 in neonates","volume":"46","author":"Venincasa","year":"2015","journal-title":"Ophthalmic Surg Lasers Imaging Retina"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e245984","DOI":"10.1136\/bcr-2021-245984","article-title":"Acute retinal necrosis with exudative retinal detachment in a child","volume":"14","author":"Perhiar","year":"2021","journal-title":"BMJ Case Rep"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e946011","DOI":"10.12659\/AJCR.946011","article-title":"Varicella zoster virus-induced retinitis and retinal detachment in an immunocompetent patient: a case report","volume":"26","author":"Kami\u0144ska","year":"2025","journal-title":"Am J Case Rep"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1016\/j.ajo.2020.06.019","article-title":"Exudative retinal detachment in ocular inflammatory diseases: risk and predictive factors","volume":"218","author":"Shah","year":"2020","journal-title":"Am J Ophthalmol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1609","DOI":"10.1080\/09273948.2021.1922926","article-title":"Cytopathology of vitreous specimens in acute retinal necrosis","volume":"30","author":"Hojjatie","year":"2022","journal-title":"Ocul Immunol Inflamm"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1746774\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T09:34:41Z","timestamp":1786700081000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1746774\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,24]]},"references-count":12,"alternative-id":["10.3389\/fmed.2026.1746774"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1746774","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,24]]},"article-number":"1746774"}}