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Br J Ophthalmol 1997;81:189-194 doi:10.1136/bjo.81.3.189
  • Original Article
    • Clinical science

Management of varicella zoster virus retinitis in AIDS

  1. Ramana S Moorthya,
  2. David V Weinbergb,
  3. Steven A Teichc,
  4. Brian B Bergerd,
  5. John T Minturne,
  6. Sanjiv Kumarf,
  7. Narsing A Raof,
  8. Susan M Fowellg,
  9. Isaac A Looseg,
  10. Lee M Jampolb
  1. aAssociated Vitreoretinal and Uveitis Consultants, Indianapolis, USA , bNorthwestern University, Chicago, USA , cMount Sinai Medical Center, New York, USA , dRetina Consultants of Texas, Austin, USA , eMidwest Eye Institute, Indianapolis, USA , fDoheny Eye Institute, Los Angeles, USA , gNorthern Illinois Retina Ltd, Rockford, USA
  1. David V Weinberg, MD, Department of Ophthalmology, Northwestern University Medical School, Suite 440, 645 N Michigan Avenue, Chicago, IL 60611, USA.
  • Accepted 4 November 1996

Abstract

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.

METHODS A 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.

RESULTS Median 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).

CONCLUSIONS This 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.

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