Treatment of Acute Retinal Necrosis

Tibbetts, Michael D.; Shah, Chirag P.; Young, Lucy H.; Duker, Jay S.; Maguire, Joseph I.; Morley, Michael G.

doi:10.1016/j.ophtha.2009.09.001

Cited by 140 publications

(204 citation statements)

References 29 publications

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“…The natural history of ARN is for 75% of affected eyes to progress to retinal detachment [17], the reported rate with intravenous acyclovir being reduced to 20-52% [7,[18][19][20][21]. Most retinal detachments occur within 6 months of presentation [20]: our patients had follow-up examinations longer than 6 months, suggesting that the risk of retinal detachment is significantly reduced. Interestingly, necrotizing herpetic retinopathies, described as a new spectrum of diseases induced by viruses of the herpes family can lead to ARN occurring in immuno-competent patients and progressive outer retinal necrosis in severely immuno-compromised patients [22].…”

Section: Discussionmentioning

confidence: 82%

“…Second eye involvement occurs in approximately a third of patients, typically within 6 weeks, although fellow eye involvement decades following an initial infection have been described [16]. The natural history of ARN is for 75% of affected eyes to progress to retinal detachment [17], the reported rate with intravenous acyclovir being reduced to 20-52% [7,[18][19][20][21]. Most retinal detachments occur within 6 months of presentation [20]: our patients had follow-up examinations longer than 6 months, suggesting that the risk of retinal detachment is significantly reduced.…”

Section: Discussionmentioning

confidence: 99%

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Valacyclovir as a Therapeutic Agent in Acute Retinal Necrosis: Two Case Reports

T¹

2014

J Clin Res Ophthalmol

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Introduction: Acute retinal necrosis (ARN) is a rare, rapidly progressive viral retinitis. The current standard of care for ARN consists of intravenous acyclovir for 5-10 days, followed by oral acyclovir for an additional 6-12 weeks. Valacyclovir has superior plasma bioavailability to acyclovir as an oral preparation. The aim of this study is to add to the evidence of treating ARN with valacyclovir with 2 additional cases.Methods: 2 patients diagnosed with ARN received treatment with valacyclovir either as a monotherapy, or in combination with intravenous acyclovir.Results: All patients had significant improvement in visual acuity within 4 weeks of the initiation of treatment. In the sixth month follow-up none of them developed retinal detachment, which is one of the commonest sight-threatening complications of ARN. Conclusions:Valacyclovir proved effective at treating retinitis in both patients. The 2 g t.i.d. dose was well tolerated and neither patient developed systemic adverse effects associated with the treatment.treatment of varicella zoster acute retinal necrosis syndrome, with good anatomic and functional results [10].Valacyclovir and famciclovir have superior plasma bioavailability to acyclovir as oral preparations [11]. The aim of the present study is to add to this evidence with 2 additional cases of ARN treated with valacyclovir . Written informed consent was obtained from the patients for publication of these case reports and any accompanying images. Case Presentation Case report 1A 22-year-old white male was referred to our Department with a 1 day history of floaters and blurred vision in his right eye. His medical history was remarkable following a diagnosis of glandular fever 4 weeks previously. Additionally, 10 days prior to presentation the patient had presented to the Neurology Department with widespread macular pruritic rash, sore throat, nausea, fever, headache, unsteadiness, weakness on the left leg, and binocular diplopia. At that time serology had confirmed an acute EBV infection with increased titres for EBVIgM antibodies. Serological testing for Human Immunodeficiency Virus (HIV), hepatitis B and C, syphilis, HSV, VZV, and CMV was negative. A computerized tomography (CT scan) of the brain was unremarkable. However, analysis of cerebrospinal fluid (CSF) had revealed 97% lymphocytic cells, a protein level of 1.44 g/L and PCR had showed positive for HHV6 viral DNA (365 DNA copies/ mL). CSF testing for HSV, VZV, EBV, CMV, and enterovirus was negative. In this setting, the patient had been diagnosed with HHV6 encephalitis and left fourth 4th nerve palsy. He had been admitted under neurological care and treated with intravenous acyclovir (1 g 3 times daily for 10 days) and pulsed intravenous methylprednisolone (1g daily for 3 days).

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Valacyclovir as a Therapeutic Agent in Acute Retinal Necrosis: Two Case Reports

T¹

2014

J Clin Res Ophthalmol

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“…Antiviral therapy is the accepted treatment for ARN, although a recent multicenter retrospective interventional series found no single treatment strategy as standard of care. 22 The current recommended treatment for adults are intravenous acyclovir 10 mg/kg every 8 hours for 10 days followed by 1000 mg of oral valacyclovir three times a day for 6-14 weeks. 22 The ideal duration and relative efficacy of this treatment remains unclear due to lack of randomized control trials.…”

Section: Discussionmentioning

confidence: 99%

“…22 The current recommended treatment for adults are intravenous acyclovir 10 mg/kg every 8 hours for 10 days followed by 1000 mg of oral valacyclovir three times a day for 6-14 weeks. 22 The ideal duration and relative efficacy of this treatment remains unclear due to lack of randomized control trials. It is known that HSV is not eliminated by valacyclovir but merely suppressed to a level where the host immunity is balanced to virus replication.…”

Section: Discussionmentioning

confidence: 99%

“…4,8,23 Published reports have also suggested that eyes that do not receive laser are more likely to have extensive disease, consistent with a higher risk of retinal detachment. 22,23 Although there is ongoing debate, most reports suggest that prophylactic barrier laser should be attempted in cases where there is limited vitritis and the retina can be visualized. 4,22,23 Other treatments include systemic corticosteroids, although they have not been proven to improve visual outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Acute retinal necrosis (ARN) in the context of neonatal HSV-2 exposure and subconjunctival dexamethasone: case report and literature review

McGrath¹,

Woods²,

Lee³

et al. 2013

Digit J Ophthalmol

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SummaryHSV-2 is an important cause of the acute retinal necrosis (ARN) syndrome in younger patients. We describe an atypical case of HSV-2 ARN in the context of neonatal exposure and subconjunctival steroid injection. Clinicians should be aware of the association of neonatal or congenital exposure to HSV-2 as a risk factor for this disease because early treatment may improve outcome and/or avoid involvement of both eyes.

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Rapid Vision Loss in a Young Woman

2018

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An otherwise healthy woman in her 30s presented to an outside health care professional with a 2-day history of floaters in her left eye. She denied additional ocular symptoms and reported no relevant medical, ocular, or family history; medication use; or allergies. The findings of a review of systems were unremarkable. A workup for posterior uveitis was initiated, and the patient began therapy with oral antiviral and oral corticosteroid medications. One week later, her symptoms had worsened, and she was referred for consultation.Best-corrected visual acuity was 20/15 OD and 20/60 OS. Intraocular pressures, extraocular movements, visual fields by confrontation, and pupil responses were normal. Anterior segment examination and dilated fundus examination of the right eye had normal findings. However, the left eye had 3+ anterior chamber cell and 1+ flare, nongranulomatous keratic precipitates, and a clear lens. The dilated fundus examination revealed 2+ vitritis, a hyperemic disc with blurred margins, macular striae with a blunted foveal reflex, and vascular sheathing with segmental periarteriolar inflammatory plaques in multiple quadrants. The peripheral retina had well-demarcated peripheral retinal whitening with scalloped margins and intraretinal hemorrhages in all quadrants (Figure 1A and B). Four days later, repeat fundus photography showed that the peripheral lesions had coalesced into larger circumferential necrotic regions (Figure 1C).

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Treatment of Acute Retinal Necrosis

Cited by 140 publications

References 29 publications

Valacyclovir as a Therapeutic Agent in Acute Retinal Necrosis: Two Case Reports

Valacyclovir as a Therapeutic Agent in Acute Retinal Necrosis: Two Case Reports

Acute retinal necrosis (ARN) in the context of neonatal HSV-2 exposure and subconjunctival dexamethasone: case report and literature review

Rapid Vision Loss in a Young Woman

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