This report describes the rapid progress of a case of unilateral acute retinal necrosis (ARN) that led to formation of a macular hole rhegmatogenous retinal detachment with advanced proliferative vitreo-retinopathy (PVR) changes over the space of 2 weeks. This necessitated primary vitrectomy with circumferential scleral buckle placement, which facilitated reattachment of the retina.