Antiviral selection in the management of acute retinal necrosis

Tam, Patrick M K; Hooper, Claire; Lightman, Susan

doi:10.2147/opth.s6390

Cited by 16 publications

(3 citation statements)

References 81 publications

(65 reference statements)

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“…In-vitro inhibitory concentrations of acyclovir for EBV are on average higher, ranging from 0.3 μM to 25 μM, compared with 0.1 μM to 2.0 μM for HSV1, and 3 μM to 4 μM VZV. 14 Cells latently infected by EBV also elude conventional antiviral therapy. Acyclovir effectively inhibits viral DNA polymerase, whereas EBV uses host cell polymerase in latent infection.…”

Section: Discussionmentioning

confidence: 99%

Epstein–barr Virus Acute Retinal Necrosis in an Immunocompetent Host

Chan

Sun

Eldeeb

et al. 2021

RETINAL Cases &Amp; Brief Reports

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Purpose: To describe a case of Epstein-Barr virus (EBV)-associated acute retinal necrosis (ARN) in an immunocompetent patient and to summarize the clinical features of published molecularly confirmed EBV-ARN cases.Methods: Case report and literature review.Results: An 83-year-old immunocompetent woman with unilateral ARN presented with visual acuity of light perception. Oral valacyclovir was started. One week later, vitrectomy was conducted for worsening inflammation. Intraoperatively, a severe confluent necrotizing retinitis and occlusive vasculitis involving all four quadrants of posterior and peripheral retina were noted. Vitreous polymerase chain reaction was exclusively positive for EBV. Other autoimmune, infective, and hematological work-up was negative. The retinitis resolved 3 months later, but with significant macular and generalized retinal atrophy, visual acuity remained light perception. From the literature, there are four EBV-ARN cases (six eyes) diagnosed based on polymerase chain reaction or fluorescence in-situ hybridization of vitreous or retinal samples. All patients were immunocompromised or on immunosuppressive treatment. Presenting visual acuity was light perception or worse in 3/6 eyes. Three patients received systemic acyclovir-based therapy. Vitrectomy was performed in 4/6 eyes between 4 and 8 weeks from disease onset. All cases had involvement of the posterior and peripheral retina. Retinal detachment occurred in 2/6 eyes, and final visual acuity was no light perception in 3/6 eyes.Conclusion: This case expands the clinical spectrum of EBV-ARN to include infection in immunocompetent hosts. Epstein-Barr virus-ARN seems to be characterized by a global peripheral and posterior fulminant retinitis, with adverse visual acuity outcomes despite systemic acyclovir-based therapy. The benefits of adjunctive intravitreal foscarnet, systemic steroids, and early vitrectomy may warrant further investigation.

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Section: Discussionmentioning

confidence: 99%

Epstein–barr Virus Acute Retinal Necrosis in an Immunocompetent Host

Chan

Sun

Eldeeb

et al. 2021

RETINAL Cases &Amp; Brief Reports

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“…In cases of severe eye damage, instead of the traditional intravenous aciclovir regimen, oral treatment with other antivirals such as famciclovir (Patrick et al. 2010) could also be considered. Boonsopon et al.…”

Section: Resultsmentioning

confidence: 99%

Anterior segment involvement in Epstein–Barr virus: a review

Alba‐Linero

Rocha‐de‐Lossada

Rachwani-Anil

et al. 2021

Acta Ophthalmologica

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The aim of this study is to describe the involvement of Epstein-Barr Virus (EBV) in the diseases of the ocular anterior segment. This is a narrative review designed using the PUBMED, SCOPE and Web of Science databases, searching for reported literature on findings in the anterior ocular segment related to EBV between 1990 and 2020. Epstein-Barr Virus (EBV) is implicated in the development of salmoncoloured conjunctival masses in the context of acute mononucleosis and lymphoproliferative disorders. Moreover, EBV can cause haemorrhagic conjunctivitis and its corneal implications appear as different types of keratitis patterns. The involvement of EBV in the pathogenesis of anterior segment inflammation is not well-defined. Current evidence regarding anterior segment disease caused by EBV infection has been proved by positive viral detection through polymerase chain reaction test in eyes with lymphoproliferative disorders known to be caused by EBV, as B-and NK/T-cell lymphoid tumours. Antiviral treatment (oral Aciclovir or Valaciclovir) in anterior segment disease caused by EBV remains controversial.

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“…Owing to the rarity of the condition, there are few randomized trials comparing different treatment regimens, and subsequently no consensus on the optimal treatment regimen or duration. 37 Historically, the standard treatment has been IV acyclovir; however, treatment with IV ganciclovir, foscarnet, and cidofovir, and more recently oral valacyclovir, valganciclovir, and famciclovir have been reported. 23 In the present study, there was a clear tendency toward using IV acyclovir as an induction antiviral treatment.…”

Section: Antiviral Treatmentmentioning

confidence: 99%

Acute Retinal Necrosis Multicenter Case Series: Prognostic Indicators and Treatment Outcomes

Dorman

Donaldson

2018

Journal of VitreoRetinal Diseases

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The purpose of this article is to report the prognostic associations of acute retinal necrosis (ARN), determine the diagnostic utility of aqueous vs vitreous polymerase chain reaction (PCR), and describe outcomes of antiviral, corticosteroid, antithrombotic, and laser retinopexy treatment. Methods: A retrospective, nonrandomized case series was conducted. Primary outcomes included final visual acuity (VA), severe VA loss (!1.00 log of the minimum angle of resolution [logMAR] [Snellen equivalent, <20/200]), and retinal detachment (RD). Results: Fifty eyes of 46 patients were diagnosed with ARN. Varicella-zoster and herpes simplex viruses were the viral etiology in 29 and 16 eyes, respectively. Five were diagnosed on clinical criteria. Intravenous acyclovir was administered in 90% of eyes. Neither induction therapy for !13 days (P ¼ .692) nor intravitreal medication (P ¼ .203) decreased the incidence of severe vision loss. Maintenance antiviral medication was administered in 96% of eyes (50% received >13 weeks). At final follow-up, 40% of eyes had severe vision loss (range,-0.08 to þ3.0 logMAR [Snellen, 20/17-no perception of light]). Forty-six percent developed RD. Relative afferent pupillary defect (RAPD), zone and extent of retinitis, and RD were prognostic of final VA. Antithrombotic therapy was administered in 25/50 eyes and was associated with lower incidence of severe VA loss (P ¼ .027) and better final VA (P ¼ .040). Laser retinopexy was performed in 40% of eyes with no significant effect on RD incidence (P ¼ .901) or severe VA loss (P ¼ .451). Conclusions: ARN has a high incidence of RD and poor visual outcomes. Aqueous humor PCR is the first-line diagnostic investigation. Prognostic indicators include RD, RAPD, zone, and extent of retinitis. Induction antiviral medication is appropriate for at least 12 days. Antithrombotic medication is associated with improved outcomes. Laser retinopexy does not reduce the incidence of RD.

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Antiviral selection in the management of acute retinal necrosis

Cited by 16 publications

References 81 publications

Epstein–barr Virus Acute Retinal Necrosis in an Immunocompetent Host

Epstein–barr Virus Acute Retinal Necrosis in an Immunocompetent Host

Anterior segment involvement in Epstein–Barr virus: a review

Acute Retinal Necrosis Multicenter Case Series: Prognostic Indicators and Treatment Outcomes

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