Late Recurrence of Acute Retinal Necrosis Within Retinal Scars.

A 56-year-old woman with previous left acute retinal necrosis (ARN) managed with panretinal photocoagulation and vitrectomy 29 years prior, presented with blurred vision, floaters, and photopsia. Visual acuities were no light perception in the right eye (retinopathy of prematurity) and 20/60 in the left eye. Examination showed keratic precipitates, hypertensive anterior uveitis and vitritis, and a solitary white-yellowish lesion within the retinal scarring, consistent with active retinitis (Fig A, widefield fundus photograph, (Fig B) magnified area of retinitis). Imaging showed thickening and disruption of the retinal architecture on spectral-domain OCT (Fig C) and hyperautofluorescence (Fig D). Aqueous polymerase chain reaction was positive for herpes simplex virus 1. This represents a unique case of ARN recurrence and the longest reported interval since the initial event. (Magnified version of Fig A-D is available online at www.aaojournal.org).