Treatment Of Acute Retinal Necrosis Research Articles

Use of intravitreal antiviral injection during vitrectomy in the treatment of acute retinal necrosis: anatomic and visual outcomes

PurposeTo investigate whether intravitreal antiviral injection (IAI) during vitrectomy reduces the postsurgical retinal detachment (RD) rate and improves the visual prognosis of patients with acute retinal necrosis (ARN).MethodsThis retrospective cohort study included ARN patients treated at a tertiary hospital between January 2013 and December 2020. Patients who underwent pars plana vitrectomy (PPV) alone or combined with intraoperative IAI were classified in PPV-only group and PPV + IAI group, respectively. The incidence of postsurgical RD and the best corrected visual acuity (BCVA) between the groups was compared. A multivariate Cox hazard analysis was employed to explore the risk factors of postsurgical RD. A multivariate logistic regression analysis was applied to assess the impact of intraoperative IAI on preventing severe vision loss (SVL).ResultsFifty-seven eyes with ARN with a median follow-up of 18.5 months were included in the study. There was no significant association between intraoperative IAI during vitrectomy and a reduced risk of postsurgical RD (hazard ratio [HR], 2.65; 95% CI, 0.71–9.89) or SVL at the 6-month follow-up visit (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.25–3.35). Better baseline best-corrected visual acuity (BCVA) was identified to associate with a higher risk of postsurgical RD (HR, 0.33; 95% CI, 0.14–0.81) and a lower risk of SVL at 6 months (OR, 2.28; 95% CI, 1.10–4.89).ConclusionWe did not observe a significant effect of intraoperative IAI on the anatomic and visual outcomes of ARN patients in this study. Intraoperative IAI may not be a necessary treatment option for ARN patients who receive vitrectomy.

Therapeutic prognostic factors associated with retinal detachment and visual outcomes in acute retinal necrosis.

Acute retinal necrosis (ARN) is a fulminant necrotizing vaso-occlusive retinitis associated with a high incidence of vision loss. Prognostic factors associated with the treatment of ARN have not been comprehensively identified. This study aimed to determine therapeutic prognostic factors associated with long-term clinical outcomes in eyes with ARN. This retrospective cohort study included patients with ARN who were treated between 2005 and 2019 in two tertiary ophthalmology departments in Seoul, Korea. Multiple logistic regression analysis was performed to investigate prognostic factors associated with late-onset retinal detachment (RD) and vision loss (<20/200). Sixty-one eyes with ARN with an average follow-up of 63.5 months were included. Surgical intervention of vitrectomy (odds ratio [OR], 0.04; 95% confidence interval [CI], 0.004-0.47) and intraoperative prophylactic laser use (OR, 0.14; 95% CI, 0.02-0.81) were independently associated with a decreased risk of late RD. The factors independently associated with an increased risk of vision loss were worse initial visual acuity (OR, 3.28; 95% CI, 1.50-7.21), zone 1 involvement of necrotic retinitis (OR, 10.84; 95% CI, 1.62-72.41), and late-onset RD (OR, 5.38; 95% CI, 1.92-31.54). Vitrectomy and/or prophylactic intraoperative laser treatment may be effective treatment options in preventing delayed RD associated with an increased risk of vision loss in eyes with ARN.

Clinically applicable artificial intelligence algorithm for the diagnosis, evaluation, and monitoring of acute retinal necrosis.

The prompt detection and proper evaluation of necrotic retinal region are especially important for the diagnosis and treatment of acute retinal necrosis (ARN). The potential application of artificial intelligence (AI) algorithms in these areas of clinical research has not been reported previously. The present study aims to create a computational algorithm for the automated detection and evaluation of retinal necrosis from retinal fundus photographs. A total of 149 wide-angle fundus photographs from 40 eyes of 32 ARN patients were collected, and the U-Net method was used to construct the AI algorithm. Thereby, a novel algorithm based on deep machine learning in detection and evaluation of retinal necrosis was constructed for the first time. This algorithm had an area under the receiver operating curve of 0.92, with 86% sensitivity and 88% specificity in the detection of retinal necrosis. For the purpose of retinal necrosis evaluation, necrotic areas calculated by the AI algorithm were significantly positively correlated with viral load in aqueous humor samples (R2=0.7444, P<0.0001) and therapeutic response of ARN (R2=0.999, P<0.0001). Therefore, our AI algorithm has a potential application in the clinical aided diagnosis of ARN, evaluation of ARN severity, and treatment response monitoring.

Advances in the Diagnosis and Management of Acute Retinal Necrosis.

Acute retinal necrosis (ARN) is a devastating syndrome characterized by panuveitis, retinal necrosis, and a high rate of retinal detachment that may result in poor visual outcomes if not promptly diagnosed and treated. ARN is most commonly caused by viruses with the herpesvirus family. Etiologies include varicella-zoster virus, herpes simplex virus, and cytomegalovirus, and may be promptly diagnosed by polymerase chain reaction testing of aqueous or vitreous fluid. The true incidence of ARN is not known due to its rarity; as a result, clinical treatment is often guided by retrospective case series, case reports, and expert opinion. Standard of care has evolved over time but currently includes a combination of systemic and intravitreal antiviral in conjunction with topical or oral steroids and surgical therapy as needed. Combination therapy may reduce the rate of severe vision loss and increase the rate of visual acuity gain, although further studies are needed in this area. In particular for patients with mild to moderate disease, combination therapy may reduce the rate of retinal detachment. Adjunctive therapies including oral corticosteroid and prophylactic laser barricade are incompletely studied, but corticosteroid in particular, may reduce inflammation, which also is involved in the severe disease pathogenesis observed in ARN. This review discusses the advances in diagnosis and treatment of ARN, including management with combination antiviral medication and surgical interventions.

Outcomes of Combination Systemic and Intravitreal Antiviral Therapy for Acute Retinal Necrosis

Determine the efficacy of combination intravitreal and systemic antiviral therapy for the treatment of acute retinal necrosis (ARN) and risk factors impacting visual acuity (VA) and retinal detachment (RD) outcomes. Single-center retrospective case series. Patients with an ARN diagnosis based on clinical features and polymerase chain reaction confirmation who were treated at a tertiary referral, university-based academic practice. Patient records were reviewed for demographic information including age and gender. Snellen VA, disease findings including RD outcomes, optic nerve involvement, and treatments were recorded. Incidence rates of major VA and RD outcomes were calculated based on the number of events and exposure times. Cox proportional hazards regression modeling and survival analyses were used to identify factors related to VA and RD outcomes over time. Logarithm of the minimal angle of resolution VA, 2-line or more VA gain, severe vision loss (SVL) of 20/200 or worse, RD development, and fellow eye involvement. Twenty-three eyes of 21 patients (11 male, 10 female) were reviewed. Thirteen patients (62%) had herpes simplex virus and 8 patients (38%) had varicella zoster virus. The event rate for 2-line or more VA gain was 0.49 events/eye-year (95% confidence interval [CI], 0.26-0.86 events/eye-year), whereas the rate of SVL was 0.61 events/eye-year (95% CI, 0.34-1.02 events/eye-year). Retinal detachment development was observed at a rate of 0.59 events/eye-year (95% CI, 0.33-1.00 events/eye-year). Thirteen of 23 eyes (57%) demonstrated RD with a mean time of 120 days after ARN diagnosis. With each additional quadrant of retina involved, a greater risk of RD development over time was observed (hazard ratio, 2.21; 95% CI, 1.12-4.35). Nine percent of eyes progressed with additional quadrantic involvement, despite combination systemic and intravitreal antiviral therapy; however, none of the 19 patients demonstrating unilateral ARN showed fellow-eye involvement after initiation of therapy. Combination intravitreal and systemic antiviral therapy for ARN can be effective in improving VA and limiting retinitis progression. Each additional quadrant of retina involved was associated with a 2.2-fold greater risk of RD, which may impact monitoring, timing of intervention, and patient counseling.

Retinal toxicity study of intravitreal ganciclovir in albino rabbit

Objective: To elevated the retinal toxicity of intravitreal ganciclovir in albino rabbit eyes. Methods: Experimental study. Twenty-four New Zealand albino rabbits (forty-eight eyes) were divided into four groups by random. Three groups were prepared for ganciclovir experiment, named A, B, C. Each group received intravitreal injection ganciclovir dose at 400 μg/0.05 ml, 2 mg/0.05 ml and 5 mg/0.05 ml respectively. The other group named D served as a control accepted intravitreal injection 0.9% normal saline 0.1 ml. Before and after 1, 2 and 4 weeks, flicker full field electroretina gram (ERG) was recorded. After 1, 2 and 4 weeks light and electron microscopic tests were recorded for further toxicity study. Results: There was significant difference in amplitude of maximal combined response a wave in one week(χ(2)=8.319, P=0.04), and pairwise comparison the 5 mg group (140.50 μV) was significantly lower than the control group (165.00 μV) (χ(2)=-2.830, P=0.028). Maximal combined response b wave in four weeks(χ(2)=-10.626, P=0.014), and pairwise comparison the 5 mg group (261.50 μV) was significantly lower than the control group (398.00 μV) (χ(2)=-2.973, P=0.018). 30 Hz flicker response in one, two and four weeks(χ(2)=17.589, 8.225, 8.997, P=0.001, 0.042, 0.02), and pairwise comparison the 5 mg group (71.3μV, 106.00μV, 63.60μV) was significantly lower than the control group (118.50μV, 129.00μV, 116.50μV) (χ(2)=-4.142, -2.826, -2.713, P=0.000, 0.028, 0.040). There was no histologic retinal toxicity evidence of group 400 μg and control group observed by light microscopy in any stage of the study. Histologic changes of group 2 mg four week later, group 5 mg two and four week later include inner nuclear layer loose arranged, nuclear of ganglia were widened and outer plexiform layer stained less in four week later. By electron microscopic observation, the ultrastructure of retina changed to different degrees and became worse in each experimental group with significant mitochondrial swelling and hydropic changes were seen in the inner segments of photoreceptors, loosely arranged and disordered in the outer segment of photoreceptors four weeks later. Conclusions: The retinal function and morphology were normal in group 400 μg. Group 2 mg and 5 mg had retinal toxicity, and 5 mg was more severe. Therefore, the clinical application of ganciclovir in the treatment of acute retinal necrosis (ARN) should select the minimum effective dose to avoid the occurrence of retinal toxicity. (Chin J Ophthalmol, 2020, 56:279-285).

Acute retinal necrosis caused by varicella zoster virus

Incidence of Herpes Zoster is relatively high. Herpes zoster ophthalmicus is one of the most common forms of the disease. Necrotising herpetic retinopathies (including acute retinal necrosis) are rare and usually these complications are presented in literature as individual cases. However, necrotising herpetic retinopathy can lead to complete loss of visual. The article reviews modern data on causation, diagnosis and treatment of acute retinal necrosis analyzing 40 open access articles from EBSCO published in 2011-2019, and describes the modern views on the prevalence and most important clinical features of herpetic acute retinal necrosis. Some contradictory opinions have been revealed concerning the diagnostic criteria and surgical treatment of acute retinal necrosis.

Selection of clinical treatments for acute retinal necrosis of varying degrees

Objective To evaluate the choice of appropriate treatment for acute retinal necrosis of varying degrees. Methods Clinical data of 26 eyes of 18 cases with acute retinal necrosis from Mar. 2014 to May 2018 were retrospectively analyzed. Some cases with severe vitreous opacity or retinal detachment received vitrectomy and some cases with less vitreous opacity and retinal necrosis received intravitreal injection of ganciclovir. Follow-up time was more than 6 months. Results Vitrectomy combined with laser photocoagulation and silicone oil tamponade were performed in 13 cases as vitrectomy group and 12 eyes received intravitreal injection of ganciclovir as injection group. BCVA after surgery in two groups were improved.The difference was statistically significant (t=3.836, P=0.0008). Conclusion 25G vitrectomy combined with laser photocoagulation or intravitreal ganciclovir injection are effective for acute retinal necrosis of varymg degrees. Key words: Necrosis, retinal, acute; Vitrectomy, 25 G; Ganciclovir, intravitreous injection

Research progress on the diagnosis and treatment of acute retinal necrosis

Acute retinal necrosis is an uncommon but devastating and potentially blinding ophthalmopathy featured with unfavorable prognosis as the lesions tend to develop rapidly in a circumferential way in few days. Therefore timely diagnosis and early treatment are of great significance. The polymerase chain reaction test on intraocular fluid can improve specificity and sensitivity of the etiological detection for acute retinal necrosis. Etiology results included in the diagnostic criteria is favorable for etiological diagnosis. Current treatment for acute retinal necrosis is generally based on systemic antiviral therapy, and supported by hormone and antithrombotic drugs, while surgical treatment should be considered when the disease progresses. This article reviews the research progress on the diagnosis and treatment of acute retinal necrosis in an effort to improve the diagnosis and treatment performance of acute retinal necrosis. (Chin J Ophthalmol, 2018, 54: 306-311).

Comparing Treatment of Acute Retinal Necrosis With Either Oral Valacyclovir or Intravenous Acyclovir

To compare the visual outcomes of patients with acute retinal necrosis (ARN) treated initially with intravenous acyclovir vs oral valacyclovir therapy. Retrospective, comparative, interventional case series. Sixty-two patients (68 eyes) with ARN, treated at Moorfields Eye Hospital (United Kingdom) between 1992 and 2016, were identified through the hospital's electronic database. Exclusion criteria included insufficient patient records or follow-up (<150days). Fifty-six patients had unilateral ARN, while 6 had bilateral ARN. Patients who received intravenous acyclovir on diagnosis (n= 33) were compared with patients treated with oral valacyclovir (n= 29) across outcomes including best-corrected visual acuity, retinal detachment, severe vision loss, and other complications. The impact of adjunctive intravitreal antiviral and prophylactic barrier laser treatment was also assessed. Change in best-corrected visual acuity was not significantly different for eyes treated initially with intravenous therapy vs oral therapy over 5 years of follow-up data (P= .16). There was no difference in the rates of severe vision loss between the 2 groups (46% and 59%, respectively, P= .18), or of those eyes retaining good vision (28% vs 31%, respectively, P=.80). Retinal detachment occurred in 63% of cases and did not differ across treatment groups (62% vs 66%, respectively, P= .67). Barrier laser and intravitreal therapy had no effect on retinal detachment rate in either group. Oral valacyclovir is clinically equivalent to intravenous therapy in the management of ARN. Oral valacyclovir as an outpatient therapy-with or without intravitreal foscarnet-can therefore be considered as an acceptable alternative to inpatient therapy required for intravenous treatment.

Результаты хирургического лечения острого некроза сетчатки

Purpose: to evaluate the effectiveness of surgical treatment of acute retinal necrosis. Material and methods. The study involves 34 patients aged 18 to 74 with acute retinal necrosis. Surgeries were performed on 41 eyes. All patients received microinvasive (23 Ga) vitrectomy with membrane peeling, endolaser coagulation of the retina and endotamponade of the vitreal cavity with silicone oil. Operated eyes were divided into 3 groups. Group 1 included 25 eyes which had retinal detachment and vitreous fibrosis at the time of surgical treatment. Group 2 consisted of 9 eyes with retinal detachment but no vitreous fibrosis, and group 3 of 7 eyes with vitreous fibrosis and no retinal detachment. Prior to surgery, visual acuity varied from wrong light perception up to 0.15 with correction. Results. A stable anatomical and optical result was achieved in all cases, complete attachment of the detached retina amounted to 94.1 %, and partial attachment to 5.9 % of the eyes. In group 1, improved visual acuity was observed in 56 % of cases, whereby visual acuity of 0.1 or higher was obtained only in 24 % of the eyes. In groups 2 and 3, visual acuity improved in all cases and proved to be 0.1 or higher, which was due to the predominance of the peripheral necrotic lesion zone, as well as to lower frequency of macular edema and optical neuropathy. In retinal detachment with vitreous fibrosis, a high frequency (72 %) of necrosis spread to the posterior pole of the eye with irreversible damage to the macula and optic nerve was detected. Conclusion. Modern technologies of surgical treatment allow achieving good anatomical results in all patients with acute retinal necrosis. The highest functional results are achieved with peripheral or paracentral lesions, absence of macular edema and optical neuropathy, and macula affected by retinal detachment prior to surgery, which was observed in groups with isolated vitreous fibrosis or retinal detachment. For citation: Neroev V.V., Ilyukhin P.A., Fedotov R.A., Tankovsky V.E. Results of surgical treatment of acute retinal necrosis. Russian ophthalmological journal. 2018; 11 (1): 5-11. doi: 10.21516/2072-0076-2018-11-1-5-11 (In Russian).

The efficacy of corticosteroid in vitrectomy for the treatment of acute retinal necrosis

Objective To investigate the efficacy of corticosteroid combined with early vitrectomy in the treatment of acute retinal necrosis(ARN). Methods Twenty-two eyes of 22 cases of ARN were analyzed retrospectively and they were randomly divided into 2 groups: the corticosteroid group, 13 cases, and the non-corticosteroid group, 9 cases.The best corrected visual acuity (BCVA) preoperative, time from diagnosis to vitrectomy, intravitreal tamponade, occurrence of retinal detachment (RD), ocular hypotony, the BCVA at final follow-up and complications were analyzed. Results The difference of common data between the 2 groups were not statistically significant. The time from diagnosis to vitrectomy in the corticosteroid group was longer than that of non-corticosteroid group (P=0.042), rate of silicon oil tamponade in corticosteroid group was higher than that of non-corticosteroid group (P=0.018), and the eyes of BCVA≥0.1 in corticosteroid group were less than those of non-corticosteroid group (P=0.041). Conclusion Prophylactic vitrectomy is recommended for the treatment of ARN, but the corticosteroid should be used with caution. Key words: Retinal necrosis, acute; Treatment, vitrectomy, corticosteroid

Valacyclovir as Initial Treatment for Acute Retinal Necrosis: A Pharmacokinetic Modeling and Simulation Study

ABSTRACTPurpose: Acute retinal necrosis (ARN) is a feared complication of infectious retinitis most commonly caused by varicella zoster virus (VZV). We performed a pharmacokinetic modeling and simulation study by integrating the existing understanding of physiology with previously published data to evaluate the vitreal penetration of oral valacyclovir for the treatment of ARN, under various dosing scenarios.Method: We compared different oral valacyclovir dosing regimens with intravenous acyclovir. The vitreous compartment was modeled as a peripheral compartment, and paired serum and vitreal acyclovir concentrations were obtained from previously published data of adult patients with ARN undergoing vitrectomy. The efficacy threshold for vitreal acyclovir concentrations was based on the previously reported IC50 values for VZV.Results: Based on the minimum vitreal acyclovir concentrations (Cmin) relative to the mean IC50 for VZV, valacyclovir 1.5 g every 8 hours performed similarly to intravenous acyclovir 700 mg every 8 hours, with the minimum concentration (Cmin) exceeding the mean IC50 after the second dose. In contrast, the standard dosing regimen for herpes zoster, valacyclovir 1 g every 8 hours, performed inferiorly to the intravenous acyclovir regimen throughout the dosing interval.Conclusions: Modeling and simulation data support oral valacyclovir for the treatment of ARN, although the required dosing exceeds the recommended FDA dose size for herpes zoster.

Diagnosis and Treatment of Acute Retinal Necrosis: A Report by the American Academy of Ophthalmology

To evaluate the available evidence in peer-reviewed publications about the diagnosis and treatment of acute retinal necrosis (ARN). Literature searches of the PubMed and Cochrane Library databases were last conducted on July 27, 2016. The searches identified 216 unique citations, and 49 articles of possible clinical relevance were reviewed in full text. Of these 49 articles, 27 were deemed sufficiently relevant or of interest, and they were rated according to strength of evidence. An additional 6 articles were identified from the reference lists of these articles and included. All 33 studies were retrospective. Polymerase chain reaction (PCR) testing of aqueous or vitreous humor was positive for herpes simplex virus (HSV) or varicella zoster virus (VZV) in 79% to 100% of cases of suspected ARN. Aqueous and vitreous specimens are both sensitive and specific. There is level II and III evidence supporting the use of intravenous and oral antiviral therapy for the treatment of ARN. Data suggest that equivalent plasma drug levels of acyclovir can be achieved after administration of oral valacyclovir or intravenous acyclovir. There is level II and III evidence suggesting that the combination of intravitreal foscarnet and systemic antiviral therapy may have greater therapeutic efficacy than systemic therapy alone. The effectiveness of prophylactic laser or early pars plana vitrectomy (PPV) in preventing retinal detachment (RD) remains unclear. Polymerase chain reaction testing of ocular fluid is useful in supporting a clinical diagnosis ofARN, but treatment should not be delayed while awaiting PCR results. Initial oral or intravenous antiviral therapy is effective in treating ARN. The adjunctive use of intravitreal foscarnet may be more effective than systemic therapy alone. The role of prophylactic laser retinopexy or early PPV is unknown at this time.

Acute Retinal Necrosis Presenting in Developmentally-delayed Patients with Neonatal Encephalitis: A Case Series and Literature Review

ABSTRACTWe report three cases of patients with developmental-delay from neonatal herpetic encephalitis and/or meningitis who presented years later with acute retinal necrosis due to herpes simplex virus. The diagnosis was delayed in all cases due to the patients’ inability to verbalize their ocular complaints and cooperate with eye examinations. This case series documents the clinical course, pathophysiologic mechanism, and treatment of acute retinal necrosis in this patient population. Clinicians should understand the importance of prudent consideration of acute retinal necrosis in patients with a history of neonatal herpetic encephalitis and/or meningitis presenting with a red eye.

Treatment of Acute Retinal Necrosis with Acute Kidney Injury after Intravenous Antiviral Injection

목적: 급성망막괴사의 치료를 위해 항바이러스제 정맥 투여 후 급성 신손상이 발생한 환자에서 정맥투여 중단 후 유리체강 내 ganciclovir 단독 주입술로 호전된 환자 1예를 보고하고자 한다. 증례요약: 46세 여자가 10일 전 시작된 우안 충혈, 시력저하로 내원하였다. 초진 당시 교정시력 우안 안전수지, 좌안 1.0이었으며, 안저 검사상 우안은 다발성 주변부 망막동맥폐쇄, 시신경부종, 주변부 망막의 백색 괴사성 침윤 등이 관찰되었다. 우안 급성망막괴사 진단하에 acyclovir 정맥투여를 시작하였다. 주사치료 2일째 혈액검사에서 혈청 크레아티닌 수치가 상승되었고 사구체 여과율은 감소하여 acyclovir에 의한 급성 신손상으로 보고 정맥주사를 중지하였다. 정맥주사 중지 직후부터 유리체강 내 ganciclovir 주입술을 시행하였으며, 중지 5일 후 혈청 크레아티닌은 정상범위로 회복되었고, 발병 4달째 나안 시력 우안 0.2로 유지되었으며, 진행 및 재발소견은 관찰되지 않았다. 결론: 유리체강 내 ganciclovir 단독 주사치료가 신장 기능이 좋지 않은 환자의 급성망막괴사 치료에 있어 효과적인 대체 치료법이 될 수 있을 것으로 생각된다.

Infectious Uveitis.

Infectious uveitis is one of the most common and visually devastating causes of uveitis in the US and worldwide. This review provides a summary of the identification, treatment, and complications associated with certain forms of viral, bacterial, fungal, helminthic, and parasitic uveitis. In particular, this article reviews the literature on identification and treatment of acute retinal necrosis due to herpes simplex virus, varicella virus, and cytomegalovirus. While no agreed-upon treatment has been identified, the characteristics of Ebola virus panuveitis is also reviewed. In addition, forms of parasitic infection such as Toxoplasmosis and Toxocariasis are summarized, as well as spirochetal uveitis. Syphilitic retinitis is reviewed given its increase in prevalence over the last decade. The importance of early identification and treatment of infectious uveitis is emphasized. Early identification can be achieved with a combination of maintaining a high suspicion, recognizing certain clinical features, utilizing multi-modal imaging, and obtaining specimens for molecular diagnostic testing.

Intravitreal triamcinolone acetonide as an adjuvant in the management of acute retinal necrosis

ObjectiveTo determine the role of intravitreal triamcinolone acetonide (IVTA) as an adjuvant in the management of acute retinal necrosis (ARN). DesignInterventional case series. ParticipantsFour eyes of 4 patients diagnosed with ARN were studied. MethodsThis pilot case series included 4 patients who presented with clinical features suggestive of ARN. IVTA was injected 1 to 2 weeks after initiation of antiviral therapy and concurrent usage of oral corticosteroids. The disease course and clinical outcome were observed. The patients received additional treatment depending on the sequelae of ARN. ResultsSigns of reduction in vitritis and resolution of retinitis were observed as early as 1 week after IVTA was administered. In all 4 patients, inflammation promptly resolved with no untoward effects like raised intraocular pressure or worsening of the retinitis. A final visual acuity of 20/40 or better was achieved in 3 of 4 patients after appropriate treatment of ARN-related complications. ConclusionsIntravitreal triamcinolone under antiviral cover could be a useful adjunct to systemic steroids in the treatment of ARN.

Valacyclovir in the treatment of acute retinal necrosis

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.

The role of intravenous immunoglobulin in treatment of acute retinal necrosis.

To describe a case of successful treatment of acute retinal necrosis with a combination of antivirals and intravenous immunoglobulin. This is a case report of a 77-year-old white man diagnosed with unilateral acute retinal necrosis. Combination therapy with systemic antivirals, prophylactic laser retinopexy, and intravenous immunoglobulin halted progression of retinitis and preserved visual acuity. Acute retinal necrosis is an aggressive disease with significant risk of vision loss even when treated with appropriate therapy. In this report, the authors describe a case of successful treatment with a combination of systemic antivirals and intravenous immunoglobulin. Intraocular antiviral injection plus systemic treatment remain to be a more cost-effective option.