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BMC Ophthalmology (1)
Clinical Ophthalmology (Auckland, N.Z.) (1)
Hooper, Claire Y (2)
Gupta, Nitin (1)
Hamilton, Robin (1)
Joshi, Lavnish (1)
Lightman, Sue L (1)
Lightman, Susan (1)
Morarji, Jiten (1)
Tam, Patrick MK (1)
Taylor, Simon RJ (1)
Year of Publication
Valacyclovir in the treatment of acute retinal necrosis
Taylor, Simon RJ
Lightman, Sue L
To report the outcome of oral valacyclovir as the sole antiviral therapy for patients with acute retinal necrosis (ARN).
This study reports a retrospective, interventional case series of nine consecutive patients with ten eyes with newly diagnosed ARN treated with oral valacyclovir as the sole antiviral agent. Eight patients received oral valacyclovir 2 g tid (Valtrex, GlaxoSmithKline) and one patient with impaired renal function received oral 1 g tid. The main outcome measures were response to treatment, time to initial response to treatment, time to complete resolution of retinitis, best corrected visual acuity (BCVA) at final follow-up, retinal detachment and development of recurrent or second eye disease.
Retinitis resolved in ten of ten (100%) affected eyes. The median time to initial detectable response was seven days and the median time to complete resolution was 21 days. A final BCVA of 20/40 or better was achieved in 6/10 (60%) of eyes. 3/10 eyes (30%) developed a retinal detachment. No patients developed either disease reactivation or second eye involvement over the course of the study (mean follow up 31 weeks, range 7 to 104 weeks).
Treatment with oral valacyclovir as the sole antiviral therapy resulted in complete resolution of retinitis. Final BCVA and retinal detachment rate were comparable with previously reported outcomes for intravenous acyclovir.
Acute retinal necrosis; Herpetic retinitis; Acyclovir; Valacyclovir
Antiviral selection in the management of acute retinal necrosis
Tam, Patrick MK
Clinical Ophthalmology (Auckland, N.Z.)
There is no consensus on the optimal antiviral regimen in the management of acute retinal necrosis, a disease caused by herpetic viruses with devastating consequences for the eye. The current gold standard is based on retrospective case series. Because the incidence of disease is low, few well-designed, randomized trials have evaluated treatment dosage and duration. Newer oral antiviral agents are emerging as alternatives to high-dose intravenous acyclovir, avoiding the need for inpatient intravenous treatment. Drug resistance is uncommon but may also be difficult to identify. Antiviral drugs have few side effects, but special attention needs to be paid to patients who have underlying renal disease, are pregnant or are immunocompromised.
acute retinal necrosis; acyclovir; herpes; retinitis
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