acyclovir and Cataract

A 20-year-old man presented with a recurrent episode of herpetic keratouveitis in his right eye. The patient was treated with oral acyclovir and topical steroids. One week later the patient reported a sudden diminution of vision. Slitlamp biomicroscopy revealed the presence of a central anterior capsular defect and anterior subcapsular cataract. Dosage of steroids was temporarily increased and progression of cataract monitored. Subsequently, the anterior chamber reaction decreased and steroids were tapered.

Topics: Acyclovir; Adrenal Cortex Hormones; Anterior Capsule of the Lens; Antiviral Agents; Cataract; Herpes Simplex; Humans; Keratitis, Herpetic; Male; Recurrence; Uveitis, Anterior; Vision Disorders; Young Adult

To report a case of herpes simplex virus-induced herpetic necrotizing retinitis after placement of a flucinolone acetonide (Retisert) intravitreal implant.. Interventional case report.. Retrospective chart review.. A 22-year-old male with idiopathic unilateral panuveitis since 2002 that was intolerant of systemic immunosuppressive therapy received a flucinolone acetonide implant 6 years later. Intraocular inflammation was completely quiescent until 1 year following the implant, when he developed retinitis. To the authors' knowledge, this is the first reported case of polymerase chain reaction-proven herpetic necrotizing retinitis following implantation of a Retisert device.. Although rare, herpetic necrotizing retinitis can occur in the setting of local ocular immunosuppression with the Retisert intravitreal implant. This potential infection should be considered in the face of recurrent uveitis following Retisert implantation.

Topics: Acyclovir; Antiviral Agents; Azathioprine; Cataract; Drug Implants; Eye Infections, Viral; Herpes Simplex; Herpesvirus 2, Human; Humans; Immunosuppressive Agents; Male; Mycophenolic Acid; Panuveitis; Pregnadienetriols; Retinal Necrosis Syndrome, Acute; Treatment Outcome; Valacyclovir; Valine; Visual Acuity; Young Adult

This is a report of an atypical case of progressive outer retinal necrosis (PORN) and the effect of highly active antiretroviral therapy (HAART) on the clinical course of viral retinitis in an acquired immunodeficiency syndrome (AIDS) patient. A 22-year-old male patient infected with human immunodeficiency virus (HIV) presented with unilaterally reduced visual acuity and a dense cataract. After cataract extraction, retinal lesions involving the peripheral and macular areas were found with perivascular sparing and the mud-cracked, characteristic appearance of PORN. He was diagnosed as having PORN based on clinical features and was given combined antiviral treatment. With concurrent HAART, the retinal lesions regressed, with the regression being accelerated by further treatment with intravenous acyclovir and ganciclovir. This case suggests that HAART may change the clinical course of PORN in AIDS patients by improving host immunity. PORN should be included in the differential diagnosis of acute unilateral cataract in AIDS patients.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiretroviral Therapy, Highly Active; Antiviral Agents; Cataract; Disease Progression; Drug Therapy, Combination; Fluorescein Angiography; Ganciclovir; Herpes Zoster Ophthalmicus; Humans; Male; Phacoemulsification; Retinal Necrosis Syndrome, Acute; Visual Acuity

To compare clinical characteristics and outcomes in patients with uveitis caused by herpes simplex virus (HSV) and varicella zoster virus (VZV).. Retrospective comparative study.. Forty patients with HSV uveitis and 24 patients with VZV uveitis.. A retrospective study of 40 patients with HSV and 24 patients with VZV uveitis was performed. The patients were followed between May 1987 and September 1999 (median follow-up time, 46 months). The diagnosis of HSV uveitis was made clinically and serologically, and the diagnosis of VZV uveitis was made clinically.. Clinical presentation of the disease, ocular complications, visual acuity, surgical and medical treatments needed.. Both populations were comparable for gender and age at disease onset. The course of the disease tended to be remitting and recurrent in HSV patients and chronic in VZV patients (P = 0.046). The most frequent ocular complication in both groups was secondary glaucoma (54% HSV, 38% VZV). Twenty-five percent of VZV patients developed posterior pole complications (cystoid macular edema, epiretinal membrane, papillitis, retinal fibrosis, and detachment) compared with 8% of HSV patients (P = 0.069). Treatment modalities selected were generally similar in the two groups, although periocular and systemic steroids were required more frequently in HSV patients (60% versus 25%; P = 0.01). Surgical procedures were required with similar frequency in both populations. The percentage of eyes that were legally blind at end of follow-up was also comparable (HSV, 20%; VZV, 21%). The visual outcome was similar in the studied populations.. This study represents the only direct comparison of HSV and VZV uveitis patients reported in the literature. HSV patients were more likely to be treated with periocular and systemic steroids, and VZV patients were more likely to develop posterior pole complications (a finding of borderline significance). Other parameters evaluated in this study were not statistically different in the two patient groups.

Topics: Acyclovir; Antiviral Agents; Cataract; Female; Glaucoma; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpesviridae Infections; Humans; Male; Middle Aged; Ophthalmologic Surgical Procedures; Recurrence; Retinal Diseases; Retrospective Studies; Uveitis; Visual Acuity

Keratitis, retinitis and secondary cataract are well known complications of ocular herpes simplex infection. We report on a case of herpetic keratouveitis and cataract. Acute and inflammatory pathogenesis of cataract formation resemble a phacoanaphylactic reaction.. A 15-year-old girl with recurrent herpes keratitis was referred for acute spontaneous cataract formation accompanied by iridocyclitis and hypotony. Visual acuity was decreased from 0.4 to light projection. During cataract extraction the anterior chamber was tabbed for immunological analysis. The thickened anterior lens capsule was examined by light microscopy. We found a significant local synthesis of herpes antibodies in the aqueous. Histologically the lens capsule depicted a defect and a granulomatous inflammatory infiltrate towards the basal membrane material. The specimen was not suitable to judge on eventual additional phacoanaphylaxis. After cataract extraction and systemic acyclovir and corticosteroids the keratouveitis subsided. Visual acuity improved to 0.4, but was limited by the disciform corneal scar.. The granulomatous response towards lens capsule shown here, resembles the granulomatous reaction towards Descemet's membrane in advanced herpetic corneal ulcer. We speculate on the pathogenesis of the lens capsule defect as a, so far unknown, herpes-associated autoimmun response against the basal membrane material of the lens. The acuteness of cataract formation may be a consequence of contact of aqueous with lens fibres. Additional phacoanaphylaxis combined with secondary glaucoma is possible.

Topics: Acyclovir; Adolescent; Anterior Chamber; Antibodies, Viral; Antiviral Agents; Aqueous Humor; Cataract; Cataract Extraction; Combined Modality Therapy; Cornea; Female; Humans; Iridocyclitis; Keratitis, Herpetic; Lens Capsule, Crystalline; Simplexvirus

The effects of several antiviral drugs on fibroblast attachment and proliferation from human Tenon's capsule were investigated. These drugs included purine nucleoside analogs, vidarabine and acyclovir (ACV); pyrimidine nucleoside analog, AZT; and a synthetic cyclic primary amine, amantadine. Fibroblast attachment and proliferation inhibition were determined by Coulter counter, a colorimetric assay of the enzyme hexosaminidase, and a 3H-thymidine uptake assay. Amantadine and AZT inhibited fibroblast attachment at concentrations higher than 6.61 x 10(-4)M and 3.73 x 10(-4) M, respectively. Amantadine and AZT had inhibitory effects on fibroblast proliferation as early as day 1, whereas vidarabine and ACV manifested their inhibitory effects after day three by Coulter counter and hexosaminidase assays. For amantadine, AZT, ACV and vidarabine, the 50% inhibitory dose (ID50) were 4.94 x 10(-5) M, 1.26 x 10(-5) M, 4.60 x 10(-4) M, and 1.52 x 10(-5) M at day 9, respectively, as measured by 3H-thymidine uptake assay. All four antiviral agents tested had inhibitory effects on human ocular fibroblast proliferation and their inhibitory potential decreased in the order of amantadine > or = vidarabine > AZT > or = ACV.

Topics: Acyclovir; Amantadine; Antiviral Agents; Cataract; Cell Division; Cell Line; Connective Tissue Cells; Depression, Chemical; Eye; Fibroblasts; Glaucoma; Humans; Vidarabine; Zidovudine

Topics: Acyclovir; Adrenal Cortex Hormones; Adult; Blindness; Cataract; Female; Humans; Retinal Necrosis Syndrome, Acute; Retinitis

Ocular involvement with acute Epstein-Barr virus infection is usually limited to a transient follicular conjunctivitis, although other lesions have been reported. Chronic Epstein-Barr virus infection has recently gained attention, but ocular manifestations have not been emphasized. We describe three patients with chronic infection with prominent ocular involvement. Bilateral uveitis was noted in all patients, ranging from an anterior uveitis that was responsive to steroids to a severe panuveitis with vitritis, cataract, optic disc swelling, and macular edema. In one patient, topical acyclovir ointment resulted in a substantial decrease in the inflammatory reaction when added to systemic acyclovir therapy. Another patient displayed a keratitis that resolved with topical steroid therapy. Cataract and vitreous surgery were also beneficial in the management of these patients.

Topics: Acyclovir; Administration, Topical; Adolescent; Adult; Cataract; Cataract Extraction; Chronic Disease; Female; Herpesvirus 4, Human; Humans; Infectious Mononucleosis; Keratitis, Dendritic; Male; Uveitis

Three herpes simplex virus mutants that contain drug resistance mutations in the DNA polymerase gene exhibited no significant reduction in replication in the ears of mice compared with the wild type after inoculation at that site but were attenuated for pathogenicity after intracerebral inoculation. Cataracts were common sequelae in mice that survived mutant infections.

Topics: Acyclovir; Animals; Cataract; Cytarabine; DNA-Directed DNA Polymerase; Drug Resistance; Encephalitis; Exodeoxyribonucleases; Female; Herpes Simplex; Mice; Mice, Inbred BALB C; Simplexvirus; Viral Proteins

Mice inoculated intracerebrally (i.c.) with a mutant strain of HSV were found to develop cataracts 1 to 2 months after inoculation. Cataract formation was subsequently shown to follow an acute retinitis which commenced within 1 week of inoculation. The mutant had been selected for high resistance to the nucleoside analogue acyclovir and has been shown previously to be defective in the induction of thymidine kinase and also to express an altered DNA polymerase. The LD50 for mice inoculated i.c. was greater than 10(5) p.f.u. compared with approx 7 p.f.u. for the parental strain. Studies of virus replication following i.c. inoculation with a sublethal dose of the mutant revealed that only small amounts of infectious virus were produced in the brain, but during a period from 6 to 12 days after inoculation vigorous replication occurred in retinal tissue, producing very high titres of virus.

Topics: Acyclovir; Animals; Antigens, Viral; Cataract; Drug Resistance, Microbial; Eye; Guanine; Hypersensitivity, Delayed; Keratitis, Dendritic; Mice; Retina; Retinitis; Simplexvirus; Time Factors; Virus Replication