title: Combination systemic and intravitreal antiviral therapy in the management of acute retinal necrosis syndrome (an American Ophthalmological Society thesis).
abstract: OBJECTIVE
  To compare the outcomes of combination systemic and intravitreal antiviral therapy vs systemic antiviral therapy alone for treating acute retinal necrosis syndrome (ARN). We hypothesize that combination therapy might result in superior visual acuity (VA) and retinal detachment (RD) outcomes vs traditional systemic antiviral therapy alone.
  
  
  METHODS
  A retrospective, interventional, comparative single-center study of patients with ARN. We reviewed demographic data, herpesvirus diagnoses, polymerase chain reaction (PCR) results, VA, RD, and the use of systemic and intravitreal antiviral therapy. Outcome measures included VA improvement by 2 or more lines, severe visual loss, VA ≤20/200, and RD.
  
  
  RESULTS
  We studied 29 eyes of 24 patients, treated from 1987 through 2009. Mean age was 42.6 years and mean follow-up was 44.0 months. Twelve patients (14 eyes) were treated with combined systemic and intravitreal antiviral therapy and 12 patients (15 eyes) with systemic therapy alone. Kaplan-Meier survival analysis revealed that patients receiving combination intravitreal and systemic antiviral therapy were more likely to have VA improved by 2 lines or greater (P=.006). Patients receiving combination therapy also showed a decreased incidence of progression to severe visual loss (0.13/patient-years [PY]) compared to patients receiving systemic therapy alone (0.54/PY, P=.02) and had decreased incidence of RD (0.29/PY vs 0.74/PY, P=.03).
  
  
  CONCLUSIONS
  Combination oral and intravitreal antiviral therapy may improve visual and functional outcomes in patients with ARN. Clinicians should consider prompt administration of combination systemic and intravitreal antiviral therapy as first-line treatment for patients with clinical features of ARN.
authors.affiliation: Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon (Dr Flaxel, Dr Lauer), and Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia (Dr Yeh).
authors.forename: Christina J
authors.initials: CJ
authors.lastname: Flaxel
authors.affiliation: Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon (Dr Flaxel, Dr Lauer), and Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia (Dr Yeh).
authors.forename: Steven
authors.initials: S
authors.lastname: Yeh
authors.affiliation: Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon (Dr Flaxel, Dr Lauer), and Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia (Dr Yeh).
authors.forename: Andreas K
authors.initials: AK
authors.lastname: Lauer
mesh_terms: D015075:2-Aminopurine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000212:Acyclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D000284:Administration, Oral; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D001082:Aqueous Humor / Q000821:virology; D003587:Cytomegalovirus / Q000302:isolation & purification; D004279:DNA, Viral / Q000032:analysis; D004359:Drug Therapy, Combination; D015828:Eye Infections, Viral / Q000175:diagnosis / Q000188:drug therapy* / Q000821:virology; D000077595:Famciclovir; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012163:Retinal Detachment; D015882:Retinal Necrosis Syndrome, Acute / Q000175:diagnosis / Q000188:drug therapy* / Q000821:virology; D012189:Retrospective Studies; D018139:Simplexvirus / Q000302:isolation & purification; D016896:Treatment Outcome; D000077483:Valacyclovir; D014633:Valine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014792:Visual Acuity / Q000502:physiology; D014822:Vitreous Body / Q000821:virology
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D015075:2-Aminopurine; D014633:Valine; D000077483:Valacyclovir; D000077595:Famciclovir; D000212:Acyclovir