Treatment of Refractory Acute Retinal Necrosis with Intravenous Foscarnet or Cidofovir.
OBJECTIVE
To report use of intravenous foscarnet or cidofovir for the treatment of refractory acute retinal necrosis (ARN).


METHODS
Retrospective chart review.


RESULTS
Four immunocompetent men aged 45-90 years presented with ARN from 2008-2014. One patient with two prior episodes of herpes simplex virus (HSV) ARN developed ARN after 6 years of antiviral prophylaxis. His condition worsened on acyclovir followed by intravenous foscarnet but responded to intravenous cidofovir (final VA in involved eye 20/20). Another patient with HSV ARN had received prolonged acyclovir prophylaxis for HSV keratitis; ARN improved after switching from acyclovir to intravenous foscarnet (final VA 20/125). Two patients with varicella zoster virus (VZV) ARN initially responded to acyclovir but developed fellow eye involvement 2-8 weeks later that worsened on acyclovir but responded to intravenous foscarnet (fellow eye final VA 20/20, 20/40).


CONCLUSIONS
Cases of HSV or VZV ARN that worsen despite intravenous acyclovir treatment may respond to intravenous foscarnet or cidofovir.
a Massachusetts Eye and Ear Infirmary , Boston , Massachusetts , USA.|b Massachusetts General Hospital , Boston , Massachusetts , USA.
Tomasz P
TP
Stryjewski
b Massachusetts General Hospital , Boston , Massachusetts , USA.
Nathan L
NL
Scott
a Massachusetts Eye and Ear Infirmary , Boston , Massachusetts , USA.|b Massachusetts General Hospital , Boston , Massachusetts , USA.
Miriam B
MB
Barshak
c Albany Medical Center , Albany , New York , USA.
Ellis H
EH
Tobin
d The Eye Associates , Sarasota , Florida , USA.
Joshua O
JO
Mali
a Massachusetts Eye and Ear Infirmary , Boston , Massachusetts , USA.|b Massachusetts General Hospital , Boston , Massachusetts , USA.
Lucy H
LH
Young
a Massachusetts Eye and Ear Infirmary , Boston , Massachusetts , USA.|b Massachusetts General Hospital , Boston , Massachusetts , USA.
C Stephen
CS
Foster
a Massachusetts Eye and Ear Infirmary , Boston , Massachusetts , USA.|b Massachusetts General Hospital , Boston , Massachusetts , USA.
Ivana K
IK
Kim
a Massachusetts Eye and Ear Infirmary , Boston , Massachusetts , USA.|b Massachusetts General Hospital , Boston , Massachusetts , USA.
Marlene L
ML
Durand
D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use*; D000077404:Cidofovir; D003596:Cytosine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D015828:Eye Infections, Viral / Q000175:diagnosis / Q000188:drug therapy* / Q000821:virology; D017245:Foscarnet / Q000627:therapeutic use*; D006561:Herpes Simplex / Q000188:drug therapy* / Q000821:virology; D006563:Herpes Zoster Ophthalmicus / Q000188:drug therapy* / Q000821:virology; D014645:Herpesvirus 3, Human / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000627:therapeutic use*; D016133:Polymerase Chain Reaction; D015882:Retinal Necrosis Syndrome, Acute / Q000175:diagnosis / Q000188:drug therapy* / Q000821:virology; D012189:Retrospective Studies; D018139:Simplexvirus / Q000235:genetics / Q000302:isolation & purification; D014822:Vitreous Body / Q000821:virology
D000998:Antiviral Agents; D063065:Organophosphonates; D017245:Foscarnet; D003596:Cytosine; D000077404:Cidofovir
Acute retinal necrosis; cidofovir; foscarnet; herpes simplex virus; herpes zoster virus