Valacyclovir in the treatment of acute retinal necrosis

Simon Rj Taylor,Jiten Morarji,Sue L Lightman,Claire Y Hooper,Lavnish Joshi,Nitin Gupta,Robin Hamilton

doi:10.1186/1471-2415-12-48

Abstract

BackgroundTo report the outcome of oral valacyclovir as the sole antiviral therapy for patients with acute retinal necrosis (ARN).MethodsThis study reports a retrospective, interventional case series of nine consecutive patients with ten eyes with newly diagnosed ARN treated with oral valacyclovir as the sole antiviral agent. Eight patients received oral valacyclovir 2 g tid (Valtrex, GlaxoSmithKline) and one patient with impaired renal function received oral 1 g tid. The main outcome measures were response to treatment, time to initial response to treatment, time to complete resolution of retinitis, best corrected visual acuity (BCVA) at final follow-up, retinal detachment and development of recurrent or second eye disease.ResultsRetinitis resolved in ten of ten (100%) affected eyes. The median time to initial detectable response was seven days and the median time to complete resolution was 21 days. A final BCVA of 20/40 or better was achieved in 6/10 (60%) of eyes. 3/10 eyes (30%) developed a retinal detachment. No patients developed either disease reactivation or second eye involvement over the course of the study (mean follow up 31 weeks, range 7 to 104 weeks).ConclusionsTreatment with oral valacyclovir as the sole antiviral therapy resulted in complete resolution of retinitis. Final BCVA and retinal detachment rate were comparable with previously reported outcomes for intravenous acyclovir.

Highlights

To report the outcome of oral valacyclovir as the sole antiviral therapy for patients with acute retinal necrosis (ARN)
Advocates of oral antiviral therapy argue that the adoption of intravenous antiviral therapy predated the discovery of valacyclovir and famciclovir, both of which have superior plasma bioavailability to acyclovir as oral preparations [13]
In three out of nine cases, the clinical diagnosis was confirmed by demonstration of herpetic viral DNA in aqueous or vitreous samples by polymerase chain reaction (PCR); in the remaining six cases, the diagnosis of presumed herpetic retinitis was made on the basis of the above clinical diagnostic criteria alone

Summary

Introduction

To report the outcome of oral valacyclovir as the sole antiviral therapy for patients with acute retinal necrosis (ARN). Acute retinal necrosis (ARN) is a rare, but potentially devastating, syndrome characterised by progressive peripheral necrotising retinitis It was first described in 1971 [1], but it took more than a decade later for its herpetic aetiology to be discovered and antiviral therapy to become the mainstay of treatment [2,3]. Advocates of oral antiviral therapy argue that the adoption of intravenous antiviral therapy predated the discovery of valacyclovir and famciclovir, both of which have superior plasma bioavailability to acyclovir as oral preparations [13] Both agents have been reported to be successful in the treatment of ARN in small case series [5,6,7,8,14]. This study adds to this evidence and is, to our knowledge, the largest consecutive case series of patients with ARN treated solely with oral valacyclovir without antecedent intravenous therapy or adjunctive intravitreal therapy

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Conclusion