title: Combination systemic and intravitreal antiviral therapy in the management of acute retinal necrosis syndrome.
abstract: OBJECTIVE
  Acute retinal necrosis (ARN) may lead to severe visual loss because of its rapid progression and high likelihood of retinal detachment (RD). This study investigates whether combination systemic and intravitreal antiviral therapy is superior to systemic antiviral therapy alone.
  
  
  METHODS
  Single-center, interventional, comparative case series of patients with ARN treated with combination systemic antiviral and intravitreal foscarnet injection therapy or systemic antiviral therapy alone. Survival analysis and incidence rates of visual acuity (VA) gain of two lines or greater, severe visual loss of 20/200 or worse, and RD were assessed.
  
  
  RESULTS
  Twelve patients received combination therapy and 12 received systemic therapy alone. Patients receiving combination therapy were more likely to gain two or more lines of VA and showed decreased incidences of severe visual loss and RD.
  
  
  CONCLUSIONS
  Combination oral and intravitreal antiviral therapy may improve the likelihood for VA gain and decrease the risk of RD in patients with ARN. Clinicians should consider administering combination systemic and intravitreal antiviral therapy for patients with the ARN syndrome.
authors.affiliation: Casey Eye Institute Retina Service, 3375 SW Terwilliger Blvd., Portland, OR 97239, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Yeh
authors.forename: Eric B
authors.initials: EB
authors.lastname: Suhler
authors.forename: Justine R
authors.initials: JR
authors.lastname: Smith
authors.forename: Beau
authors.initials: B
authors.lastname: Bruce
authors.forename: Gary
authors.initials: G
authors.lastname: Fahle
authors.forename: Steven T
authors.initials: ST
authors.lastname: Bailey
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Hwang
authors.forename: J Timothy
authors.initials: JT
authors.lastname: Stout
authors.forename: Andreas K
authors.initials: AK
authors.lastname: Lauer
authors.forename: David J
authors.initials: DJ
authors.lastname: Wilson
authors.forename: James T
authors.initials: JT
authors.lastname: Rosenbaum
authors.forename: Christina J
authors.initials: CJ
authors.lastname: Flaxel
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage; D018450:Disease Progression; D015828:Eye Infections, Viral / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D017245:Foscarnet / Q000008:administration & dosage*; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D015882:Retinal Necrosis Syndrome, Acute / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000187:drug effects*
chemical_list: D000998:Antiviral Agents; D017245:Foscarnet