Primary treatment of acute retinal necrosis with oral antiviral therapy.
OBJECTIVE
To explore the possibility of oral antiviral therapy in lieu of intravenous acyclovir for treating acute retinal necrosis (ARN), a necrotizing retinopathy caused by herpes simplex virus type 1 or 2 or by varicella zoster virus.


METHODS
Retrospective, interventional, small case series.


METHODS
Four patients (6 eyes).


METHODS
Patients were treated with oral antiviral therapy. Medications included valacyclovir (1 g 3 times daily), oral famciclovir (500 mg 3 times daily), and topical and oral corticosteroids.


METHODS
Improvement of symptoms, including photophobia, blurred vision, ocular discomfort, and floaters; increase in visual acuity; and resolution of vitreitis, retinitis, and retinal vasculitis, where present.


RESULTS
Symptoms and visual acuity improved within 2 weeks to 1 month in 3 of 4 patients (75%) treated with oral antiviral medication. One patient required surgical treatment for asymptomatic retinal detachment after 3 weeks of treatment; retinal detachment in the fellow eye was repaired 2 months later. Duration of antiviral therapy ranged from 5 weeks to 3 months.


CONCLUSIONS
For 4 patients with relatively indolent cases of ARN, oral antiviral therapy alone was effective in eliminating signs and symptoms of the disease. In particular, oral valacyclovir and famciclovir appeared to be effective, although further study is necessary to determine whether these drugs are as effective as intravenous acyclovir for initial treatment of ARN.
Emerson
Geoffrey G
GG
Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA.
Smith
Justine R
JR
Wilson
David J
DJ
Rosenbaum
James T
JT
Flaxel
Christina J
CJ
D015075:2-Aminopurine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000212:Acyclovir / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D017726:Cytomegalovirus Retinitis / Q000188:drug therapy* / Q000821:virology; D004359:Drug Therapy, Combination; D000077595:Famciclovir; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006561:Herpes Simplex / Q000188:drug therapy* / Q000821:virology; D006563:Herpes Zoster Ophthalmicus / Q000188:drug therapy* / Q000821:virology; D018259:Herpesvirus 1, Human / Q000302:isolation & purification; D018258:Herpesvirus 2, Human / Q000302:isolation & purification; D014645:Herpesvirus 3, Human / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D015882:Retinal Necrosis Syndrome, Acute / Q000188:drug therapy* / Q000821:virology; D012189:Retrospective Studies; D000077483:Valacyclovir; D014633:Valine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014792:Visual Acuity; D014822:Vitreous Body / Q000821:virology
D000998:Antiviral Agents; D005938:Glucocorticoids; D015075:2-Aminopurine; D014633:Valine; D000077483:Valacyclovir; D000077595:Famciclovir; D000212:Acyclovir