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A 21-year-old man with acute retinal necrosis showed a marked increase in the convalescent titer to herpes simplex type 1 virus, especially in the aqueous humor obtained by anterior chamber paracentesis. Using an enzyme-linked immunosorbent assay, we tried to detect the herpesvirus antigen in the circulating immune complex obtained from this patient. The immune complex contained an antigen or antigens that reacted with anti-herpes simplex type 1 antibody.

Six patients had peripheral to midperipheral pale yellow retinal exudates typical of acute retinal necrosis syndrome but which extended gradually to the posterior pole and remained isolated without becoming confluent. These exudates resulted in localized retinochoroidal degeneration without retinal detachment, in contrast to acute retinal necrosis syndrome. Antibody titers in aqueous humor were increased to varicella-zoster virus in some of the patients examined. The findings led us to hypothesize that this mild, self-limiting course is one of the natural developments of acute retinal necrosis syndrome, although somewhat modified by corticosteroid or acyclovir therapy, and that acute retinal necrosis syndrome consists of varying degrees of severity from mild to fulminant types.