[Brivudine as an alternative systemic therapy to aciclovir and ganciclovir in acute retinal necrosis syndrome due to varicella-zoster virus].
BACKGROUND
Two cases of acute retinal necrosis (ARN-) syndrome caused by an infection with varicella zoster virus (VZV) are demonstrated. VZV-DNA was detected in vitreous biopsies by polymerase-chain-reaction (PCR). The course of retinal necrosis was decisively improved by changing antiviral therapy from aciclovir and/or ganciclovir to brivudine.


METHODS
Patient 1: 51 years, male, initial visual acuity 20/40; patient 2: 17 years, female, initial visual acuity 20/30. Both patients were immunocompetent and presented with an unilateral acute retinal necrosis syndrome with peripheral chorioretinitis, retinal vasculitis, vitreous inflammation and optic disc swelling, which resulted in progressive visual loss in a few days.


RESULTS
In both patients VZV-DNA was detected in vitreous biopsies with PCR. A regression of intraocular inflammation and necrotic retinal foci was only observed after changing the initial systemic therapy from aciclovir (Zovirax) intravenously 1500 mg/day) and/or ganciclovir (Cymeven) intravenously 250 mg/day) to brivudine (Zostex) per os 500 mg/day). Vitreoretinal surgery was necessary in both patients because of rhegmatogenous retinal detachment. Visual acuity stabilised in patient 1 to 20/200 and in patient 2 to 20/25 during a follow-up of 16 or 32 months, respectively.


CONCLUSIONS
Brivudine represents an alternative therapy, if standard treatment with aciclovir and/or ganciclovir failed in cases of ARN-syndrome due to presumed drug-resistant varicella zoster virus-subtypes. Complete remission and preservation of a satisfactory function can be achieved.
Vij
Oliver
O
Abteilung für Erkrankungen des hinteren Augenabschnitts, Zentrum für Augenheilkunde der Universität Essen.
Bornfeld
Norbert
N
Roggendorf
Michael
M
Fiedler
Melanie
M
Schilling
Harald
H
D000212:Acyclovir / Q000008:administration & dosage* / Q000009:adverse effects; D000284:Administration, Oral; D000293:Adolescent; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001973:Bromodeoxyuridine / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D015774:Ganciclovir / Q000008:administration & dosage* / Q000009:adverse effects; D006563:Herpes Zoster Ophthalmicus / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D015882:Retinal Necrosis Syndrome, Acute / Q000175:diagnosis / Q000188:drug therapy*; D019233:Retreatment; D017211:Treatment Failure
D000998:Antiviral Agents; C020235:brivudine; D001973:Bromodeoxyuridine; D015774:Ganciclovir; D000212:Acyclovir