Intravitreal injection of Ganciclovir in the treatment of acute retinal necrosis

Abstract

To evaluate the indication and clinical effects of intravitreal injection of Ganciclovir in the treatment of acute retinal necrosis (ARN). Fourteen cases (14 eyes) of ARN which were consistent with the diagnostic criteria of American Uveitis Society were enrolled. Preoperative visual acuity was: light perception, hand movement and counting fingers (CF), each in 1 eye; 0.08 - 0.1 in 4 eyes; 0.2 - 0.4 in 5 eyes 0.5 in 1 eye and 0.8 in 1 eye. Keratic precipitate and aqueous flare were presented in the anterior segment. Peripheral focal and/or patch retinal necrosis, retinal occlusive arteritis and retinal hemorrhage were observed in the fundus. Acyclovir or Ganciclovir was administrated systematically by intravenous injection. The condition of 14 eyes deteriorated underwent intravitreal injection of Ganciclovir but without retinal detachment. After intravitreal injection 2 eyes became worse and underwent vitrectomy for PVR and retinal detachment. The follow-up time varied from 4 to 74 months (mean 25 months). The inflammation of anterior segment and vitreoretinopathy of 14 cases disappeared after intravitreal injection of Ganciclovir. The visual acuity markedly increased in 12 eyes without surgical intervention. Visual acuity achieved 1.0 - 1.5 in 5 eyes, 0.5 - 0.9 in 5 eyes and 0.3 in 2 eyes after intravitreal injection of Ganciclovir. The retina of the 2 eyes undergone vitrectomy was reattached and their visual acuity improved from CF to 0.4 and LP to CF, respectively. In ARN patients whose conditions could not be controlled by systemic antivirus medicine treatment, early intravitreal injection of Ganciclovir can yield satisfactory therapeutic effects and better visual prognoses if applied before the occurrence of PVR or retinal detachment.