Her aqueous tap was positive for Varicella Zoster virus and she was treated with oral and intravitreal antivirals, along with In immunosuppressed individuals, PORN is the second most common form of infectious retinitis, after cytomegalovirus retinitis, but it is much more aggressive than CMV retinitis and can have even more dire consequences.The most common setting in which PORN occurs is that of a patient with AIDS. In contrast to ARN, in PORN the posterior pole may be involved early in the course of the disease, vitreous inflammatory cells are typically absent, the retinal vasculature is minimally involved, at least initially (The natural course of the disease is rapid progression to blindness. 1998 Jan;26(1):34-45; discussion 46-7. This disease process was generally found to occur in otherwise healthy patients. Infectious: CMV retinitis, ARN, Syphilitic retinitis, Toxoplasma retinochoroiditis, tuberculosis, toxocariasis, fungal or bacterial endophthalmitis In 1990, Forster and colleagues identified a syndrome affecting immunocompromised individuals and coined the term "progressive outer retinal necrosis," or PORN. We report a case of progressive outer retinal necrosis (PORN) in a patient of microscopic polyangitis (MPA), being treated with immunosuppressive drugs such as cyclophosphamide and rituximab. Prophylactic laser barricade of areas of retinal necrosis has not been shown to be effective in preventing retinal detachment in PORN, though it has shown success in ARN. Pain and photophobia that are present in ARN are notably absent in PORN, since the anterior segment is not involved. One review (Wong, R.J. et. Primary treatment includes antiviral agents both intravitreally and intravenously. The final outcome is a blind eye with atrophic retina and a pale optic nerve. Common labs ordered are VZV-PCR, HSV-1, 2 PCR, CMV PCR. Retinal necrosis is inflicted predominantly through direct intraretinal spread of the replicating virus. Vitreous tap with viral PCR analysis is typically performed to isolate the pathogen. The most common etiologic agent is Varicella Zoster Virus, followed by Herpes Simplex Virus. Median final visual acuity was shown to be count fingers, and is likely correlated to visual acuity at presentation. The use of adjunctive corticosteroids is generally not necessary in PORN because minimal inflammation is observed. Refer to In general, the differential diagnosis for PORN is similar to that of ARN (see prior discussion and Unlike ARN, PORN does not respond very well to systemic antiviral therapy. al) identified VZV as the etiologic agent in 71.5% of cases of PORN. Fluorescein angiography (FA) findings can be variable. Rapidly progressive herpetic retinal necrosis: a blinding disease characteristic of advanced AIDS. Progressive outer retinal necrosis syndrome (PORN) is a severe clinical variant of necrotizing herpetic chorioretinitis, which occurs almost exclusively in patients with advanced acquired immunodeficiency syndrome (AIDS). Atrophy of the RPE and all layers of the neurosensory retina in areas of prior necrosis may also be evident. In the event of retinal detachment, a frequent occurrence following necrosis of the outer retina, surgical repair with silicone oil has been found to be effective. Progressive outer retinal necrosis (PORN) is a rapidly evolving and destructive condition of the retina. Less than approximately 40% of patients have an anterior chamber reaction and less than 20% have vitreous cell. Original descriptions of the disease emphasized posterior pole involvement, with initial multifocal lesions throughout the posterior pole that progressed later to confluence, and involved the peripheral retina at late stages. If present, it was found to be predominantly 1+ only. Approximately 66% of patients treated with only systemic antiviral therapy have been shown to progress to NLP, whereas those receiving prompt intravitreal antiviral therapy retain better vision-- median final VA is count fingers, and only 33% of patients progressed to NLP by 7 month follow-up. However, more recent reports show that deep necrosis can be present in any or multiple parts of the outer retina. This unusual event might be related The essential distinguishing feature of these diseases is the host response: an exuberant inflammatory uveitis accompanies ARN in patients capable of mounting an immune response, while a silent, minimally inflammatory retinitis afflicts patients with PORN. Retinal vasculature, the predominant modality for treatment was intravenous antiviral therapy as well prognosis ( approximately 2/3 of complain! Occur in otherwise healthy patients can rapidly progress to full thickness necrosis, or PORN is. 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