Management of varicella zoster virus retinitis in AIDS

• Published in: British journal of ophthalmology Vol. 81; no. 3; pp. 189 - 194
• Main Authors: Moorthy, Ramana S, Weinberg, David V, Teich, Steven A, Berger, Brian B, Minturn, John T, Kumar, Sanjiv, Rao, Narsing A, Fowell, Susan M, Loose, Isaac A, Jampol, Lee M
• Format: Journal Article
• Language: English
• Published: BMA House, Tavistock Square, London, WC1H 9JR BMJ Publishing Group Ltd 01.03.1997; BMJ; BMJ Publishing Group LTD
• Subjects: Acquired Immunodeficiency Syndrome - complications; Acyclovir - therapeutic use; Adult; AIDS; AIDS-Related Opportunistic Infections - drug therapy; AIDS/HIV; Analysis of Variance; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiviral agents; Antiviral Agents - therapeutic use; antiviral therapy; Biological and medical sciences; Biopsy; Eye Infections, Viral - complications; Eye Infections, Viral - drug therapy; Female; Foscarnet - therapeutic use; Ganciclovir - therapeutic use; Gangrene; Herpes Zoster - complications; Herpes Zoster - drug therapy; Herpesvirus 3, Human - isolation & purification; Hispanic people; Hospitals; Humans; Lasers; Male; Medical sciences; Middle Aged; Original articles - Clinical science; Pharmacology. Drug treatments; Retinal Detachment - etiology; Retinal Detachment - surgery; Retinitis - complications; Retinitis - drug therapy; Retrospective Studies; Site selection; Surgery; Thin film coatings; Treatment Outcome; varicella zoster virus retinitis; Visual Acuity; New York; United States > US; Acyclic nucleoside; Purine nucleoside; Retinopathy; Alphaherpesvirinae; Ganciclovir; Aciclovir; Antiviral; Human; Varicella zoster virus; Immunopathology; Enzyme; Herpesviridae; Transferases; Foscarnet sodium; Enzyme inhibitor; AIDS; Immune deficiency; Infection; Virus; Eye disease; Chemotherapy; Nucleotidyltransferases; Treatment; Viral disease; Retinitis
• ISSN: 0007-1161; 1468-2079
• DOI: 10.1136/bjo.81.3.189

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.