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Japanese Journal of Ophthalmology

, Volume 59, Issue 1, pp 14–20 | Cite as

Development and validation of new diagnostic criteria for acute retinal necrosis

  • Hiroshi Takase
  • Annabelle A. Okada
  • Hiroshi Goto
  • Nobuhisa Mizuki
  • Kenichi Namba
  • Nobuyuki Ohguro
  • Koh-Hei Sonoda
  • Makoto Tomita
  • Hiroshi Keino
  • Takeshi Kezuka
  • Reo Kubono
  • Kazuomi Mizuuchi
  • Etsuko Shibuya
  • Hiroyuki Takahashi
  • Ryoji Yanai
  • Manabu MochizukiEmail author
Clinical Investigation

Abstract

Purpose

The purposes of this study are to develop and validate new diagnostic criteria for acute retinal necrosis (ARN) based on the ocular findings, clinical course, and virologic testing of intraocular fluids.

Subjects and methods

The Japanese ARN Study Group, comprising 8 uveitis specialists and 1 statistician, was formed to develop new diagnostic criteria for ARN. The criteria used a combination of clinical features consistent with ARN including 6 early-stage ocular findings ([1a] anterior chamber cells or mutton-fat keratic precipitates; [1b] yellow-white lesion(s) in the peripheral retina [granular or patchy in the early stage, then gradually merging]; [1c] retinal arteritis; [1d] hyperemia of the optic disc; [1e] inflammatory vitreous opacities; and [1f] elevated intraocular pressure), 5 clinical courses ([2a] rapid expansion of the retinal lesion(s) circumferentially, [2b] development of retinal breaks or retinal detachment, [2c] retinal vascular occlusion, [2d] optic atrophy, and [2e] response to antiviral agents), and the results of virologic testing of intraocular fluids by means of either polymerase chain reaction or the Goldmann-Witmer coefficient for herpes simplex virus or varicella zoster virus. Various combinations of findings were analyzed to maximize the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The criteria were then used to retrospectively analyze patients who had been diagnosed as having ARN or control uveitis. Patients were followed at 1 of 7 tertiary uveitis clinics between 2009 and 2011.

Results

Analysis of the data allowed delineation of 2 levels of diagnosis: “virus-confirmed ARN” (defined as the presence of both early-stage ocular findings 1a and 1b, the presence of any 1 of the 5 clinical courses, and a positive virologic test result) and “virus-unconfirmed ARN” (defined as the presence of 4 of 6 early-stage ocular findings including 1a and 1b, presence of any 2 of the 5 clinical courses, and a negative virologic test result, or when virologic testing had not been performed). The new diagnostic criteria were applied to 45 patients with ARN and 409 patients with control uveitis, resulting in a sensitivity of 0.89, a specificity of 1.00, a PPV of 1.00, and an NPV of 0.99.

Conclusions

New diagnostic criteria for ARN were developed and found to achieve high statistical values.

Keywords

Acute retinal necrosis Infectious uveitis Diagnostic criteria Polymerase chain reaction Goldmann-Witmer coefficient 

Notes

Acknowledgments

We thank Dr. Norio Usui for his thoughtful comments and discussions. This study was supported by a Health and Labour Sciences Research Grant for research on rare and intractable diseases from the Ministry of Health, Labour and Welfare of Japan.

Conflicts of interest

H. Takase, None; A. A. Okada, None; H. Goto, None; N. Mizuki, None; K. Namba, None; N. Ohguro, None; K.-H. Sonoda, None; M. Tomita, None; H. Keino, None; T. Kezuka, None; R. Kubono, None; K. Mizuuchi, None; E. Shibuya, None; H. Takahashi, None; R. Yanai, None; M. Mochizuki, None.

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Copyright information

© Japanese Ophthalmological Society 2014

Authors and Affiliations

  • Hiroshi Takase
    • 1
    • 9
  • Annabelle A. Okada
    • 2
    • 9
  • Hiroshi Goto
    • 3
    • 9
  • Nobuhisa Mizuki
    • 4
    • 9
  • Kenichi Namba
    • 5
    • 9
  • Nobuyuki Ohguro
    • 6
    • 9
  • Koh-Hei Sonoda
    • 7
    • 9
  • Makoto Tomita
    • 8
    • 9
  • Hiroshi Keino
    • 2
    • 9
  • Takeshi Kezuka
    • 3
    • 9
  • Reo Kubono
    • 1
    • 9
  • Kazuomi Mizuuchi
    • 5
    • 9
  • Etsuko Shibuya
    • 4
    • 9
  • Hiroyuki Takahashi
    • 1
    • 9
  • Ryoji Yanai
    • 7
    • 9
  • Manabu Mochizuki
    • 1
    • 9
    Email author
  1. 1.Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityTokyoJapan
  2. 2.Department of Ophthalmology, School of MedicineKyorin UniversityMitakaJapan
  3. 3.Department of OphthalmologyTokyo Medical UniversityTokyoJapan
  4. 4.Department of Ophthalmology and Visual ScienceYokohama City University Graduate School of MedicineYokohamaJapan
  5. 5.Department of OphthalmologyHokkaido University Graduate School of MedicineSapporoJapan
  6. 6.Department of OphthalmologyJapan Community Health Care Organization Osaka HospitalOsakaJapan
  7. 7.Department of OphthalmologyYamaguchi University Graduate School of MedicineUbeJapan
  8. 8.Tokyo Medical and Dental University Hospital of Medicine, Clinical Research CenterTokyoJapan
  9. 9.Japanese Acute Retinal Necrosis Study GroupTokyoJapan

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