{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:30:52Z","timestamp":1760146252374,"version":"build-2065373602"},"reference-count":52,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,10,23]],"date-time":"2024-10-23T00:00:00Z","timestamp":1729641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Bilateral acute retinal necrosis (BARN) represents a broad ophthalmological field of severe retinal pathologies associated with poor visual prognosis and blindness. The purpose of this review is to examine the clinical spectrum in detail over the past few years, exploring laboratory and instrumental diagnosis, and providing useful and up-to-date guidance in this field. A systematic review of this field has been performed through the PRISMA guidelines, searching in the PUBMED database. Serological laboratory tests on blood or polymerase chain reaction (PCR) on aqueous humor or vitreous samples are crucial to identifying the underlying cause and choosing the timeliest strategic treatments. Often, the main cause remains herpesviruses, with Varicella zoster (VZV) predominating over the others. There are also other causes that one needs to be carefully aware of. Anatomical and functional recovery is unfavorable if they are not individuated in a quick time. Early diagnosis and timely treatment offer a better chance of visual improvement and the avoidance of complications. Complications worsen the visual prognosis over months and may require a surgical approach.<\/jats:p>","DOI":"10.3390\/medicina60111735","type":"journal-article","created":{"date-parts":[[2024,10,23]],"date-time":"2024-10-23T04:28:43Z","timestamp":1729657723000},"page":"1735","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical Spectrum and Perspective in Bilateral Acute Retinal Necrosis: Systematic Review"],"prefix":"10.3390","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6193-3299","authenticated-orcid":false,"given":"Valeria","family":"Albano","sequence":"first","affiliation":[{"name":"Department of Basic Medical Sciences, Neurosciences and Sensory Organs, Eye Clinic, University Hospital Polyclinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariantonietta","family":"Di Brina","sequence":"additional","affiliation":[{"name":"Department of Basic Medical Sciences, Neurosciences and Sensory Organs, Eye Clinic, University Hospital Polyclinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Grazia","family":"Pignataro","sequence":"additional","affiliation":[{"name":"Department of Basic Medical Sciences, Neurosciences and Sensory Organs, Eye Clinic, University Hospital Polyclinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1904-1262","authenticated-orcid":false,"given":"Giacomo","family":"Scotti","sequence":"additional","affiliation":[{"name":"Department of Basic Medical Sciences, Neurosciences and Sensory Organs, Eye Clinic, University Hospital Polyclinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0486-1839","authenticated-orcid":false,"given":"Camilla","family":"Di Pardo","sequence":"additional","affiliation":[{"name":"Department of Basic Medical Sciences, Neurosciences and Sensory Organs, Eye Clinic, University Hospital Polyclinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4045-4785","authenticated-orcid":false,"given":"Giovanni","family":"Petruzzella","sequence":"additional","affiliation":[{"name":"Department of Basic Medical Sciences, Neurosciences and Sensory Organs, Eye Clinic, University Hospital Polyclinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Salvelli","sequence":"additional","affiliation":[{"name":"Department of Basic Medical Sciences, Neurosciences and Sensory Organs, Eye Clinic, University Hospital Polyclinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosanna","family":"Dammacco","sequence":"additional","affiliation":[{"name":"Department of Basic Medical Sciences, Neurosciences and Sensory Organs, Eye Clinic, University Hospital Polyclinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvana","family":"Guerriero","sequence":"additional","affiliation":[{"name":"Department of Basic Medical Sciences, Neurosciences and Sensory Organs, Eye Clinic, University Hospital Polyclinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Alessio","sequence":"additional","affiliation":[{"name":"Department of Basic Medical Sciences, Neurosciences and Sensory Organs, Eye Clinic, University Hospital Polyclinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Mayer, C.S., Blobner, K., Storr, J., Baur, I.D., and Khoramnia, R. (2022). Acute Retinal Necrosis: Signs, Treatment, Complications and Outcome. Diagnostics, 12.","DOI":"10.3390\/diagnostics12020386"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2462","DOI":"10.1097\/IAE.0000000000003277","article-title":"Uveitis following the BNT162b2 mRNA vaccination against SARS-CoV-2 infection: A possible association","volume":"41","author":"Rabinovitch","year":"2021","journal-title":"Retina"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1136\/bjo.2010.191288","article-title":"Four cases of bilateral acute retinal necrosis with a long interval after the initial onset","volume":"95","author":"Okunuki","year":"2011","journal-title":"Br. J. Ophthalmol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Mapelli, C., Milella, P., Don\u00e0, C., Nassisi, M., Osnaghi, S., Viola, F., Agostoni, C., Minoia, F., and Filocamo, G. (2022). Acute Retinal Necrosis: Clinical Features, Diagnostic Pitfalls, Treatment, and Outcome of an Insidious Disease in Children. Case Report and Review of the Literature. Front. Pediatr., 10.","DOI":"10.3389\/fped.2022.854325"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/0039-6257(91)90183-G","article-title":"Diagnosis and management of the acute retinal necrosis (ARN) syndrome","volume":"35","author":"Duker","year":"1991","journal-title":"Surv. Ophthalmol."},{"key":"ref_6","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"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1136\/bjo.62.9.581","article-title":"Bilateral acute retinal necrosis","volume":"62","author":"Young","year":"1978","journal-title":"Br. J. Ophthalmol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1016\/j.ophtha.2006.08.037","article-title":"Acute Retinal Necrosis","volume":"114","author":"Lau","year":"2007","journal-title":"Ophthalmol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/j.ajo.2008.07.043","article-title":"Polymerase Chain Reaction Analysis of Aqueous and Vitreous Specimens in the Diagnosis of Posterior Segment Infectious Uveitis","volume":"147","author":"Harper","year":"2009","journal-title":"Am. J. Ophthalmol."},{"key":"ref_10","first-page":"69","article-title":"Acute retinal necrosis: Insights into pathogenesis from the mouse model","volume":"8","author":"Atherton","year":"2001","journal-title":"Herpes"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/S0002-9394(14)76725-X","article-title":"Decrease in the Risk of Bilateral Acute Retinal Necrosis by Acyclovir Therapy","volume":"112","author":"Palay","year":"1991","journal-title":"Am. J. Ophthalmol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1931","DOI":"10.2147\/OPTH.S258488","article-title":"Management Strategies of Acute Retinal Necrosis: Current Perspectives","volume":"14","author":"Powell","year":"2020","journal-title":"Clin. Ophthalmol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1097\/IAE.0000000000002341","article-title":"Bilateral acute retinal necrosis: A case series","volume":"40","author":"Lei","year":"2020","journal-title":"Retina"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.1080\/09273948.2018.1501494","article-title":"Bilateral Acute Retinal Necrosis: Clinical Features and Outcomes in a Multicenter Study","volume":"27","author":"Miserocchi","year":"2019","journal-title":"Ocul. Immunol. Inflamm."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"NP120","DOI":"10.1177\/11206721211006576","article-title":"Bilateral acute retinal necrosis during treatment with alemtuzumab for multiple sclerosis","volume":"32","author":"Menean","year":"2022","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Petrillo, F., Petrillo, A., Sasso, F.P., Schettino, A., Maione, A., and Galdiero, M. (2022). Viral Infection and Antiviral Treatments in Ocular Pathologies. Microorganisms, 10.","DOI":"10.3390\/microorganisms10112224"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/S0002-9394(98)00250-5","article-title":"Bilateral acute retinal necrosis caused by cytomegalovirus in an immunocompromised patient","volume":"127","author":"Akpek","year":"1999","journal-title":"Am. J. Ophthalmol."},{"key":"ref_19","first-page":"451","article-title":"Epstein-Barr virus and acute retinal necrosis in a 5-year-old immunocompetent child","volume":"2","author":"Harto","year":"2008","journal-title":"Clin. Ophthalmol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1971","DOI":"10.1016\/j.ophtha.2009.03.029","article-title":"Acute Retinal Necrosis: Clinical Features, Early Vitrectomy, and Outcomes","volume":"116","author":"Hillenkamp","year":"2009","journal-title":"Ophthalmology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1136\/bjo.2004.042226","article-title":"Necrotising retinopathies simulating acute retinal necrosis syndrome","volume":"89","author":"Balansard","year":"2005","journal-title":"Br. J. Ophthalmol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1080\/09273948.2023.2181188","article-title":"Acute Retinal Necrosis Associated with Pseudorabies Virus Infection: A Case Report and Literature Review","volume":"32","author":"Xu","year":"2023","journal-title":"Ocul. Immunol. Inflamm."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"NP94","DOI":"10.1177\/1120672120974941","article-title":"Atypical bilateral acute retinal necrosis in a coronavirus disease 2019 positive immunosuppressed patient","volume":"32","author":"Gupta","year":"2022","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/S0161-6420(99)90014-3","article-title":"Identification of BK virus in a patient with acquired immune deficiency syndrome and bilateral atypical retinitis","volume":"106","author":"Hedquist","year":"1999","journal-title":"Ophthalmology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/j.ajo.2005.09.033","article-title":"Necrotizing Retinitis Induced by Angiostrongylus cantonensis","volume":"141","author":"Liu","year":"2006","journal-title":"Am. J. Ophthalmol."},{"key":"ref_26","first-page":"909","article-title":"Outcomes of infectious panuveitis associated with simultaneous multi-positive ocular fluid polymerase chain reaction","volume":"44","author":"Chau","year":"2024","journal-title":"Retina"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1007\/BF00930316","article-title":"Wegener\u2019s granulomatosis, pituitary adenoma and BARN","volume":"18","author":"Murray","year":"1995","journal-title":"Int. Ophthalmol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1080\/09273948.2019.1635168","article-title":"Development of Acute Retinal Necrosis in a Patient with Ocular Sarcoidosis: A Case Report","volume":"27","author":"Takayama","year":"2019","journal-title":"Ocul. Immunol. Inflamm."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1097\/ICB.0b013e3182670ec3","article-title":"Extensive choroidal infiltrates in choroidal biopsy proven ocular sarcoidosis","volume":"7","author":"Chen","year":"2013","journal-title":"Retin. Cases Brief Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/s12348-016-0095-y","article-title":"Bilateral acute retinal necrosis in a patient with multiple sclerosis on natalizumab","volume":"6","author":"Sood","year":"2016","journal-title":"J. Ophthal. Inflamm. Infect."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/S0002-9394(03)00095-3","article-title":"Acute retinal necrosis following epidural steroid injections","volume":"136","author":"Browning","year":"2003","journal-title":"Am. J. Ophthalmol."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Webre, J.M., Hill, J.M., Nolan, N.M., Clement, C., McFerrin, H.E., Bhattacharjee, P.S., Hsia, V., Neumann, D.M., Foster, T.P., and Lukiw, W.J. (2012). Rabbit and Mouse Models of HSV-1 Latency, Reactivation, and Recurrent Eye Diseases. J. Biomed. Biotechnol., 2012.","DOI":"10.1155\/2012\/612316"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Oh, J.J., Carter, J.J., and Dix, R.D. (2021). A Mouse Model That Mimics AIDS-Related Cytomegalovirus Retinitis: Insights into Pathogenesis. Pathogens, 10.","DOI":"10.3390\/pathogens10070850"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1016\/j.ophtha.2016.11.007","article-title":"Diagnosis and Treatment of Acute Retinal Necrosis","volume":"124","author":"Schoenberger","year":"2017","journal-title":"Ophthalmology"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1016\/S0140-6736(14)61035-7","article-title":"Acute retinal necrosis presenting as bilateral acute angle closure","volume":"384","author":"Kaushik","year":"2014","journal-title":"Lancet"},{"key":"ref_36","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\u2013Positive Patients","volume":"179","author":"Butler","year":"2017","journal-title":"Am. J. Ophthalmol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"28","DOI":"10.21037\/aes-2019-dmu-09","article-title":"Advances in the diagnosis and management of acute retinal necrosis","volume":"5","author":"Anthony","year":"2020","journal-title":"Ann Eye Sci."},{"key":"ref_38","doi-asserted-by":"crossref","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. Retin. Vitr."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1007\/s10384-012-0211-y","article-title":"Acute retinal necrosis: Factors associated with anatomic and visual outcomes","volume":"57","author":"Azumi","year":"2013","journal-title":"Jpn J. Ophthalmol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"202","DOI":"10.4103\/0974-9233.58423","article-title":"Differential diagnosis of retinal vasculitis","volume":"16","author":"Herbort","year":"2009","journal-title":"Middle East Afr. J. Ophthalmol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/S0021-5155(02)00480-X","article-title":"Indocyanine Green Angiographic Findings in Acute Retinal Necrosis","volume":"46","author":"Takei","year":"2002","journal-title":"Jpn. J. Ophthalmol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2049","DOI":"10.1007\/s00417-015-3051-x","article-title":"Spectral domain and swept source optical coherence tomography findings in acute retinal necrosis","volume":"253","author":"Keino","year":"2015","journal-title":"Graefe\u2019s Arch. Clin. Exp. Ophthalmol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s12348-023-00331-8","article-title":"En-face widefield optical coherence tomography angiography for understanding vascular networks changes in two cases of acute retinal necrosis","volume":"13","author":"Tomita","year":"2023","journal-title":"J. Ophthal. Inflamm. Infect."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1097\/ICB.0000000000000778","article-title":"Optical coherence tomography angiography findings in acute retinal necrosis","volume":"15","author":"Martines","year":"2021","journal-title":"Retin. Cases Brief Rep."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/S0161-6420(86)33740-0","article-title":"Treatment of the Acute Retinal Necrosis Syndrome with Intravenous Acyclovir","volume":"93","author":"Blumenkranz","year":"1986","journal-title":"Ophthalmology"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"866","DOI":"10.4103\/ijo.IJO_954_17","article-title":"Bilateral acute retinal necrosis associated with bilateral uveal effusion in an immunocompetent patient: A challenging association","volume":"66","author":"Velis","year":"2018","journal-title":"Indian J. Ophthalmol."},{"key":"ref_47","first-page":"631","article-title":"Intravitreal injection of Ganciclovir in the treatment of acute retinal necrosis","volume":"43","author":"Guo","year":"2007","journal-title":"Zhonghua Yan Ke Za Zhi"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e87","DOI":"10.3928\/15428877-20110901-06","article-title":"Intravitreal Ganciclovir and Dexamethasone as Adjunctive Therapy in the Management of Acute Retinal Necrosis Caused by Varicella Zoster Virus","volume":"42","author":"Kishore","year":"2011","journal-title":"Ophthalmic Surg. Lasers Imaging"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1016\/S0002-9394(00)00462-1","article-title":"Intravitreal antiviral injections as adjunctive therapy in the management of immunocompetent patients with necrotizing herpetic retinopathy","volume":"129","author":"Luu","year":"2000","journal-title":"Am. J. Ophthalmol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1097\/IAE.0b013e3181c7013c","article-title":"Long-term follow-up of acute retinal necrosis","volume":"30","author":"Meghpara","year":"2010","journal-title":"Retina"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"399","DOI":"10.3928\/23258160-20140908-02","article-title":"Combination Systemic and Intravitreal Antiviral Therapy in the Management of Acute Retinal Necrosis Syndrome","volume":"45","author":"Yeh","year":"2014","journal-title":"Ophthalmic Surg Lasers Imaging Retin."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/j.virol.2018.09.012","article-title":"Corrigendum to \u201cAntibody-based immunotherapy of acyclovir resistant ocular herpes simplex virus infection\u201d [Virology 512 (2017) 194\u2013200]","volume":"526","author":"Bauer","year":"2019","journal-title":"Virology"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/11\/1735\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:18:21Z","timestamp":1760113101000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/11\/1735"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,23]]},"references-count":52,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["medicina60111735"],"URL":"https:\/\/doi.org\/10.3390\/medicina60111735","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2024,10,23]]}}}