Incidence and treatment patterns of acute retinal necrosis: a nationwide population-based cohort study

AIMS: To quantify nationwide incidence and contemporary treatment patterns of acute retinal necrosis (ARN). METHODS: Retrospective cohort using Japan's National Database of Health Insurance Claims and Specific Health Checkups, which covers >95% of claims. New-onset ARN (2016-2022) was identified by ARN diagnostic codes plus antiviral therapy. Annual, age-specific and sex-specific incidence rates used governmental denominators; age-standardised rates used the WHO world standard. Surgical management (vitreoretinal surgery, silicone oil (SO)/perfluorocarbon (PFC) use, glaucoma surgery) was assessed up to 2 years after diagnosis. RESULTS: Among 586 incident cases (313 men, 273 women), crude incidence was 0.066 (95% CI 0.061 to 0.072) per 100 000 person-years; the age-standardised rate was 0.040 per 100 000 person-years. Incidence rose with age, peaking at 70-74 years, and was consistently higher in men than in women. Vitreoretinal surgery occurred in 42.4% by 30 days and 59.4% by 365 days after diagnosis; 25.1% underwent ≥2 procedures within 1 year. SO or PFC was used in 40.8% by 1 year. Glaucoma surgery was uncommon (