Optimal timing and efficacy of prophylactic pars plana vitrectomy in acute retinal necrosis: insights from literature and clinical practice

Acute retinal necrosis (ARN) is a rare but vision-threatening disease. Retinal detachment (RD) is a common complication that leads to severe vision loss. Molecular analysis of the aqueous or vitreous humor using polymerase chain reaction (PCR) enables precise diagnosis and facilitates timely therapeutic intervention. Although antiviral therapy is the cornerstone of managing ARN, pharmacological treatment alone often fails to prevent RD. Therefore, pars plana vitrectomy (PPV) is often considered before RD develops in clinical practice. However, its role in this setting and the optimal timing of surgery have yet to be clearly defined and remain debated. In this review, we propose that the timing of prophylactic PPV is better considered in relation to fundus visibility and the presence or evolution of structural risk, rather than as a fixed time point after diagnosis.