Elsevier

Ophthalmology

Volume 114, Issue 2, February 2007, Pages 307-312
Ophthalmology

Original Article
Treatment of Acute Retinal Necrosis Syndrome with Oral Antiviral Medications

https://doi.org/10.1016/j.ophtha.2006.06.058Get rights and content

Objective

Acute retinal necrosis (ARN) is a distinct ocular viral syndrome traditionally treated with intravenous acyclovir followed by oral acyclovir. We investigated the use of the oral antiviral medications valacyclovir and famciclovir as the sole treatment for patients with newly diagnosed ARN syndrome.

Design

Retrospective, uncontrolled, interventional case series.

Participants

Eight consecutive patients with newly diagnosed ARN treated solely with oral antiviral medications.

Intervention

All patients received famciclovir or valacyclovir without antecedent intravenous therapy. One patient with bilateral ARN treated with famciclovir received a single intravitreal injection of foscarnet in the more severely involved eye.

Main Outcome Measures

Clinically and photographically documented complete resolution of retinitis and best-corrected visual acuity on final follow-up.

Results

Active retinitis resolved completely in 10/10 (100%) affected eyes. Initial response to treatment was seen as early as 4 days (in 5 eyes), with a median time to complete resolution of 14 days. At the last examination, visual acuity was improved (≥ 2 Snellen lines) in 6 (60%) eyes, stable in 2 (20%) eyes, and worse in 2 (20%) eyes. Over a mean follow-up of 36 weeks (range, 7–72 weeks), 3 eyes developed rhegmatogenous retinal detachment that was successfully repaired with 1 vitrectomy surgery. No patient with initially unilateral involvement developed disease in the contralateral eye.

Conclusions

In this pilot study, the use of the oral drugs valacyclovir and famciclovir resulted in complete regression of herpetic necrotizing retinitis. Additional studies are necessary to evaluate the role of these antiherpetic medications in the treatment of the ARN syndrome.

Section snippets

Patients and Methods

This study was a retrospective, uncontrolled, interventional case series of consecutive patients with symptomatic ARN syndrome treated solely with oral antiviral medications at a university hospital vitreoretinal service.

Results

Patient demographic, medical history, and diagnostic data are summarized in Table 1. The 5 men and 3 women in this series ranged in age at symptom onset from 15 to 90 years (median, 44 years). Three of the 8 patients had been previously diagnosed with systemic malignancies. Non–insulin-dependent diabetes mellitus was present in 2 patients. Five patients had a history of previous cutaneous or neurologic herpetic infection.

All patients in this series presented with complaints of decreased and

Discussion

Acute retinal necrosis syndrome is an infectious uveitis usually caused by HSV-1 or -2 or VZV.2, 3, 4 It has a bimodal age distribution peaking at approximately 20 and 50 years of age.5 Although there is no clear racial association with ARN, some individuals may be immunologically predisposed to developing the ARN syndrome. Holland et al10 found that > 50% of ARN patients had HLA-DQw7 antigen compared with 19% of matched controls. Also, 16% of ARN patients expressed HLA-Bw62DR4 phenotype

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      Citation Excerpt :

      Patients who received both antivirals IVT and systemic therapy compared to systemic therapy alone showed slightly improved visual outcomes and decreased risk of retinal detachment.26 However, systemic antivirals are the mainstay of treatment to arrest progression of retinal necrosis in the affected eye and to prevent involvement of the fellow eye.27,28 While early treatment of ARN is critical to prevent irreversible damage, there is currently no definitive therapeutic protocol.

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    Manuscript no. 2006-44.

    The authors have no financial interests in any devices or products mentioned in the article.

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