Management of varicella zoster virus retinitis in AIDS
a Associated
Vitreoretinal and Uveitis Consultants, Indianapolis, USA
, b Northwestern University,
Chicago, USA , c Mount Sinai Medical Center, New York, USA
, d Retina Consultants
of Texas, Austin, USA , e Midwest
Eye Institute, Indianapolis, USA , f Doheny Eye Institute, Los Angeles, USA , g Northern Illinois Retina Ltd,
Rockford, USA
Correspondence to: David V Weinberg, MD, Department of Ophthalmology, Northwestern University Medical School, Suite 440, 645 N Michigan Avenue, Chicago, IL 60611, USA.
Accepted for publication 4 November 1996
AIMS/BACKGROUND
Varicella zoster virus
retinitis (VZVR) in patients with AIDS, also called progressive outer
retinal necrosis (PORN), is a necrotising viral retinitis which has
resulted in blindness in most patients. The purposes of this study were
to investigate the clinical course and visual outcome, and to determine
if the choice of a systemic antiviral therapy affected the final visual outcome in patients with VZVR and AIDS.
METHODSA review of the clinical records
of 20 patients with VZVR from six centres was performed. Analysis of
the clinical characteristics at presentation was performed.
Kruskall-Wallis non-parametric one way analysis of variance (KWAOV) of
the final visual acuities of patients treated with acyclovir,
ganciclovir, foscarnet, or a combination of foscarnet and ganciclovir
was carried out.
RESULTSMedian follow up was 6 months
(range 1.3-26 months). On presentation, 14 of 20 patients (70%) had
bilateral disease, and 75% (15 of 20 patients) had previous or
concurrent extraocular manifestations of VZV infection. Median initial
and final visual acuities were 20/40 and hand movements, respectively.
Of 39 eyes involved, 19 eyes (49%) were no light perception at last
follow up; 27 eyes (69%) developed rhegmatogenous retinal detachments.
Patients treated with combination ganciclovir and foscarnet therapy or
ganciclovir alone had significantly better final visual acuity than
those treated with either acyclovir or foscarnet (KWAOV: p = 0.0051).
CONCLUSIONSThis study represents the
second largest series, the longest follow up, and the first analysis of
visual outcomes based on medical therapy for AIDS patients with VZVR.
Aggressive medical treatment with appropriate systemic antivirals may
improve long term visual outcome in patients with VZVR. Acyclovir
appears to be relatively ineffective in treating this disease.
© 1997 by British Journal of Ophthalmology
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