Treatment of Acute Retinal Necrosis Syndrome with Oral Antiviral Medications

• Published in: Ophthalmology (Rochester, Minn.) Vol. 114; no. 2; pp. 307 - 312
• Main Authors: Aizman, Alexander, MD, Johnson, Mark W., MD, Elner, Susan G., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2007; Elsevier
• Subjects: 2-Aminopurine - analogs & derivatives; 2-Aminopurine - therapeutic use; Acyclovir - analogs & derivatives; Acyclovir - therapeutic use; Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents - therapeutic use; Biological and medical sciences; Eye Infections, Viral - drug therapy; Eye Infections, Viral - virology; Female; Follow-Up Studies; Herpes Simplex - drug therapy; Herpes Simplex - virology; Herpes Zoster Ophthalmicus - drug therapy; Herpes Zoster Ophthalmicus - virology; Humans; Male; Medical sciences; Miscellaneous; Ophthalmology; Pilot Projects; Retinal Necrosis Syndrome, Acute - drug therapy; Retinal Necrosis Syndrome, Acute - virology; Retrospective Studies; Valine - analogs & derivatives; Valine - therapeutic use; Visual Acuity; Drug; Chemotherapy; Acute retinal necrosis syndrome; Treatment; Oral administration; Antiviral; Ophthalmology
• ISSN: 0161-6420; 1549-4713
• DOI: 10.1016/j.ophtha.2006.06.058

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.