acyclovir and Retinal-Detachment

Necrosis retiniana aguda por virus herpes simple tipo 1 a los tres años de una encefalitis herpetica.

Topics: Acyclovir; Antiviral Agents; Aspirin; Cataract Extraction; Causality; Drug Therapy, Combination; Encephalitis, Herpes Simplex; Herpes Simplex; Herpesvirus 1, Human; Humans; Male; Methylprednisolone; Middle Aged; Recurrence; Retinal Detachment; Retinal Hemorrhage; Retinal Necrosis Syndrome, Acute; Time Factors; Valacyclovir; Valine; Vitrectomy

This report pertains to the case of a 25-year-old patient suffering from acute necrotizing retinitis (ANR syndrome). Initially, one eye revealed clinical signs of diffuse chorioretinitis accompanied by perivasculitis and heavy keratic precipitates, papillitis, and vitreous infiltrates. After initial improvement under antiphlogistic therapy, however, necrotizing retinitis developed, associated with peripapillar hemorrhages, multiple peripheral retinal holes and eventually complete retinal detachment. The subsequently performed retinal detachment surgery, completed with vitrectomy, cerclage and silicone oil tamponade, was successful. At the same time, the patient was put on systemic therapy based on acyclovir. In the literature, similar developments are usually related to HSV and HZV infections. Although in our case a virological diagnostic test did not reveal the presence of any virus, the characteristic symptoms of the ANR syndrome completely disappeared under the above-mentioned therapy. Visual acuity, previously consisting only in light perception, improved to 0.4.

Topics: Acyclovir; Adult; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Visual Acuity; Vitrectomy

Ganciclovir (BW B759U, DHPG, dihydroxy propoxymethyl guanine) was injected directly into the vitreous in 14 eyes of 11 patients with severe acquired immune deficiency syndrome (AIDS)-associated cytomegalovirus (CMV) retinitis. All 11 patients either demonstrated serious myelosuppression which precluded the continuation of intravenous ganciclovir therapy (5 patients) or were experiencing progressive CMV retinitis despite therapy with maximum-tolerable dosages of intravenous ganciclovir (6 patients). Suppression of the retinitis was observed in 11 (78%) of the 14 treated eyes. Three eyes (22%) showed no improvement after the initial intravitreal injection. One rhegmatogenous retinal detachment (RD) occurred during an injection. There were no other complications, and no intraocular drug toxicity was observed. Reactivation of CMV retinitis necessitated repeated injections in 9 (64%) of the 14 eyes. The authors' experience with these 30 intravitreal injections indicates that the procedure is safe and effective both as an alternative to intravenous ganciclovir therapy in myelosuppressed patients and as a supplement to intravenous therapy in uncontrolled CMV retinitis.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Clinical Trials as Topic; Cytomegalovirus Infections; Fundus Oculi; Ganciclovir; Humans; Injections; Injections, Intravenous; Male; Ophthalmoscopy; Retinal Detachment; Retinitis; Retrospective Studies; Vitreous Body

Acute retinal necrosis (ARN) caused by human herpes virus type 6 (HHV-6) is uncommon. We described a case of consecutive bilateral ARN, which was found to be a coinfection of varicella zoster virus (VZV) and HHV-6 in a 50-year-old woman, not well responded with systemic acyclovir. We showed the atypical findings with corresponding fundus and optical coherence tomography imaging.. She presented with anterior segment inflammation with peripheral retinitis and vasculitis in the left eye with disease progression despite of initial antiviral treatment, end up with retinal detachment. The right eye, subsequently, developed focal retinitis.. ARN was diagnosed by clinical fundus picture, confirmed by polymerase chain reaction (PCR).. Initially, she was treated with intravenous acyclovir and intravitreal ganciclovir for left eye. Retinal necrosis progressed, followed by retinal detachment. Pars plana vitrectomy with silicone oil was performed. The right eye, subsequently, developed focal retinitis. Medication was switched to intravenous ganciclovir and then oral valganciclovir.. Retinitis was resolved, generalized hyperpigmentation appeared as a salt-and-pepper appearance in the right eye. The left eye presented preretinal deposits on silicone-retina interphase along retinal vessels. Spectral-domain optical coherence tomography (SD-OCT) showed multiple hyperreflective nodules on retinal surface.. ARN from coinfection of VZV and HHV-6 is rare. Preretinal granulomas and generalized hyperpigmentation could be one of the HHV-6 features. HHV-6 should be in the differential diagnosis for ARN. It responds well to systemic ganciclovir.

Topics: Acyclovir; Coinfection; Female; Ganciclovir; Herpesvirus 3, Human; Herpesvirus 6, Human; Humans; Middle Aged; Retina; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Retinitis; Retinitis Pigmentosa

To describe a patient with recurrent acute retinal necrosis (ARN), her treatment, and propose a possible pathophysiologic mechanism.. Case report.. A 4-year-old girl presented elsewhere with bilateral ARN, was treated, but developed a retinal detachment in the left eye that failed vitrectomy surgery. She was referred 10 years later with recurrent ARN. The infection was difficult to get under control, but eventually responded to intravenous acyclovir and foscarnet. She was given laser photocoagulation. She was placed on oral valacyclovir prophylaxis and was disease-free for 10 years at which point she decided to go to South America on vacation and stop her valacyclovir. Within a few days she developed a recurrence of ARN and flew back for treatment. She had discrete areas of retinal necrosis, vasculitis, and the laser photocoagulation lesions seemed to be ringed by a retinal change suggestive of retinitis. She responded to antiviral treatment, but developed a retinal detachment that was successfully treated. Her visual acuity was 20/20 six years later, and she was using antiviral prophylaxis.. Recurrent ARN can respond to aggressive treatment. Chorioretinal scars, such as from photocoagulation, may be potential sites of viral invasion during recurrences. Antiviral prophylaxis may be indicated for at-risk patients.

Topics: Acyclovir; Antiviral Agents; Child, Preschool; Female; Foscarnet; Humans; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Valacyclovir

Due to the guarded prognosis of acute retinal necrosis (ARN), it is relevant to develop a strategy to early categorize those patients in a higher risk of worse outcomes. The purpose of this study is to describe clinical features and predictive factors for retinal detachment (RD) in patients with ARN.. Retrospective observational case series of 34 adult patients (38 eyes) with ARN examined between January 2005 and July 2015 in the National Eye Institute (Bethesda, USA), the Department of Ophthalmology, University of Chile (Santiago, Chile), and APEC (CDMX, Mexico).. A total of 16 males and 18 females with a mean age at presentation of 44.5 ± 16.8 years were included. Twenty-seven patients (79.4%) received intravenous acyclovir as first-line treatment, and 7 patients received either oral antiviral (4 patients) or oral plus intravitreal antiviral (3 patients). All subjects were treated with prednisone, with a mean initial dose of 57.7 ± 16.3 mg per day. Seventeen patients (50.0%) developed retinal detachment. An association of retinal detachment with age at onset was observed (p = 0.04), with patients younger than 50 years presenting a higher risk (OR = 14.86, p = 0.0009). Additionally, patients in this higher risk group had more inflammation in both anterior chamber and vitreous (p = 0.04 and 0.03, respectively). No other predictive factor for retinal detachment was found in the present study.. RD represents an important complication in patients with ARN. Younger patients may be at higher risk of this complication, possibly secondary to the presence of a higher level of inflammation.

Topics: Acyclovir; Adult; Female; Humans; Male; Middle Aged; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Visual Acuity

Topics: Acyclovir; Administration, Intravenous; Adult; Cataract Extraction; Combined Modality Therapy; Ganciclovir; Herpesvirus 3, Human; HIV Infections; Humans; Immune Reconstitution Inflammatory Syndrome; Intravitreal Injections; Lens Implantation, Intraocular; Male; Polymerase Chain Reaction; Prednisolone; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Treatment Outcome; Valacyclovir

We report the case of a patient who presented with viral encephalitis and a pulmonary infection complicated with bilateral acute retinal necrosis after direct contact with diseased swine. Next-generation sequencing of the cerebrospinal fluid and vitreous humor detected pseudorabies virus (PRV) simultaneously. Intravenous acyclovir and dexamethasone treatment improved the symptoms of encephalitis, and vitrectomy surgery with silicone oil tamponade was used to treat the retinal detachment. This case implies that PRV can infect humans; thus, self-protection is imperative when there is contact with animals.

Topics: Acyclovir; Adult; Animals; Anti-Inflammatory Agents; Antiviral Agents; Cerebrospinal Fluid; Dexamethasone; Encephalitis, Viral; Herpesvirus 1, Suid; Humans; Lung Diseases; Male; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Silicone Oils; Swine; Swine Diseases; Vitrectomy; Vitreous Body; Zoonoses

Herpes simplex virus (HSV) can affect the central nervous system causing meningitis, encephalitis and, rarely, acute retinal necrosis. We present a case of a 46-year-old man, previously healthy complaining of a 5-day persistent headache and sudden loss of vision of his left eye that progressed to the right. We started ceftriaxone, methylprednisolone and acyclovir for suspected encephalitis with vasculitis. HSV-1 was identified in vitreous and aqueous humour. Therapy with acyclovir was maintained and two intravitreous boluses of foscarnet were administered, without improvement. Usually being a benign infection, HSV can, in rare cases like this, have catastrophic effects in the optic tract.

Topics: Acyclovir; Administration, Intravenous; Antiviral Agents; Eye Infections, Viral; Herpesvirus 1, Human; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Vitreous Body

A retired woman with left ophthalmic shingles of over 2 years' duration attended with bilateral vision loss and systemic upset. Acute retinal necrosis with detachment was detected on right fundus examination. Cataract in left eye precluded funduscopy. Ocular ultrasonography revealed fibrotic retinal detachment in the left eye. MRI brain and orbits also showed signals of retinal detachment. No abnormal MRI signal within the optic nerve or brain was found. Varicella zoster virus was detected in ocular aqueous and blood samples. High-dose intravenous acyclovir was administered. HIV test was positive with a very low CD4 count. Antiretroviral medications were prescribed. There was no recovery of vision. She was certified as blind, and social services were involved in seeking to provide alterations to her home in view of her severe disability. This case highlights the importance of suspecting HIV in patients with severe or chronic ophthalmic shingles. Images and implications for clinical practice are presented.

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Anti-Retroviral Agents; Antiviral Agents; Blindness; Diagnosis, Differential; Female; Herpes Zoster; HIV Infections; Humans; Magnetic Resonance Imaging; Patient Safety; Retinal Detachment; Retinal Diseases; Retinal Necrosis Syndrome, Acute; Ultrasonography; Varicella Zoster Virus Infection

Topics: Acyclovir; Aged; Anti-Inflammatory Agents; Antiviral Agents; Confusion; Encephalitis, Herpes Simplex; Fever; Humans; Magnetic Resonance Imaging; Male; Nausea; Prednisolone; Retinal Detachment; Spinal Puncture; Treatment Outcome; Vitrectomy

Topics: Acyclovir; Adrenal Cortex Hormones; Adult; CD4-Positive T-Lymphocytes; CD8-Positive T-Lymphocytes; Endophthalmitis; Herpes Simplex; Herpesvirus 1, Human; Humans; Male; Plasma Cells; Retina; Retinal Detachment; Vitreous Body

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Aqueous Humor; DNA, Viral; Drug Therapy, Combination; Eye Infections, Viral; Female; Fluorescein Angiography; Ganciclovir; Herpes Simplex; Herpesvirus 1, Human; Humans; Infusions, Intravenous; Intravitreal Injections; Macular Edema; Middle Aged; Polymerase Chain Reaction; Prednisolone; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Tomography, Optical Coherence

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Chorioretinitis; Drug Combinations; Exudates and Transudates; Eye Infections, Viral; Fluorescein Angiography; Foscarnet; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Intravitreal Injections; Male; Middle Aged; Ophthalmic Solutions; Parasympatholytics; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Tropanes; Valacyclovir; Valine

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.. 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.. 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).. 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.

Topics: 2-Aminopurine; Acyclovir; Administration, Oral; Adult; Antiviral Agents; Aqueous Humor; Cytomegalovirus; DNA, Viral; Drug Therapy, Combination; Eye Infections, Viral; Famciclovir; Female; Humans; Injections, Intravenous; Intravitreal Injections; Male; Middle Aged; Polymerase Chain Reaction; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Simplexvirus; Treatment Outcome; Valacyclovir; Valine; Visual Acuity; Vitreous Body

To investigate the clinical course of patients with acute retinal necrosis (ARN) in order to evaluate the efficacy of treatment.. Clinical characteristics, causative virus, treatment and clinical course were analyzed in 14 eyes of 14 patients with ARN who presented between December 2000 and April 2008.. All patients were treated with systemic anti-viral agents. Four eyes (29%) did not develop retinal detachment nor did they undergo prophylactic vitreous surgery; 3 of these eyes were of patients with baseline systemic diseases and were in a state of relative immunosuppression. Rhegmatogenous retinal detachment occurred in 6 eyes (43%) for which vitreous surgery with silicone oil tamponade was performed. Successful retinal reattachment was obtained in 5 of these eyes, although the silicone oil could not be removed in 3 eyes judged to be at high risk for recurrent detachment. Prophylactic vitreous surgery was performed in 3 eyes (21%) that had no retinal detachment. The indication for surgery in these eyes was an acute worsening of vitreous haze obscuring view of the fundus. Two of these eyes required a second surgical procedure, but all 3 eyes maintained useful vision with final attachment of the retina.. Good outcomes were obtained in ARN patients who at baseline were in a state of relative immunosuppression, suggesting a role for strong immune reactions in the development of retinal detachment in ARN. Silicone oil could not be removed in most eyes that had undergone vitreous surgery after the onset of retinal detachment. Indications for the use of prophylactic vitreous surgery for ARN eyes without retinal detachment require further evaluation.

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Antiviral Agents; Female; Humans; Immunocompromised Host; Male; Middle Aged; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Silicone Oils; Treatment Outcome; Vitreous Body; Young Adult

To study the effects of intravitreal foscarnet and the clinical differences between varicella zoster virus (VZV) and herpes simplex virus (HSV) induced acute retinal necrosis (ARN).. Retrospective comparative case series.. Eighty-one eyes of 74 patients.. A retrospective case note analysis was performed in 2 tertiary referral centers.. Presenting and final visual acuity, and progression to retinal detachment.. Thirty-three eyes had HSV-ARN and 48 had VZV-ARN. The average age for HSV-ARN was 34 years and 51 for VZV-ARN (P<0.001). Visual acuity on presentation was similar (P = 0.48), but a larger proportion had better vision (> or =20/60) in the HSV-ARN group (52%) than the VZV-ARN group (35%). A greater proportion of eyes with poor vision (< or =20/200) was found at the 12-month follow-up in the VZV-ARN group (60%) compared with the HSV-ARN group (35%). A greater degree of visual loss in the VZV-ARN group (0.4 logarithm of the minimum angle of resolution [logMAR]) compared with the HSV-ARN group (0.04 logMAR) was detected (P = 0.016). Retinal detachment was 2.5-fold more common in VZV-ARN (62%) compared with HSV-ARN (24%). When comparing eyes treated with (n = 56) and without (n = 25) intravitreal foscarnet, there was a 40% lower rate in retinal detachment (53.6% vs 75.0%) for VZV-ARN (P = 0.23). The numbers with HSV-ARN were too small for analysis.. The results support the difference of outcome in HSV-ARN and VZV-ARN. Therefore, viral identification serves as a key to predicting outcome in these patients. Intravitreal foscarnet seems to be a useful adjunct for the treatment of ARN in that it reduced rate of retinal detachment.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Child; Eye Infections, Viral; Female; Foscarnet; Herpes Simplex; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Infusions, Intravenous; Male; Middle Aged; Polymerase Chain Reaction; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Simplexvirus; Visual Acuity; Vitreous Body; Young Adult

To study the demographics, clinical features, treatment, and visual outcomes of progressive outer retinal necrosis (PORN) in a group of Thai patients.. All cases of AIDS with a clinical diagnosis of PORN in a major tertiary referral hospital in southern Thailand between January 2003 and June 2007 were retrospectively reviewed. Demographic data, clinical features, treatment regimens, and visual outcomes were analyzed.. Seven patients (11 eyes) were studied. The mean age was 44.7 years. The median CD4 count was 12 cells/mm3. A known history of cutaneous zoster was documented in 57% of cases. The median follow-up period was 17 weeks. Fifty-seven percent of the patients had bilateral disease. A majority of eyes (45.4%) had initial visual acuity of less than 20/50 to equal to or better than 20/200. About two-thirds of the eyes had anterior chamber cells. Vitritis and retinal lesions scattered throughout both posterior pole and peripheral retina were found in 72.7%. Either intravenous acyclovir in combination with intravitreal ganciclovir injections or intravenous aclyclovir alone was used for initial treatment. Retinal detachment occurred in 54.5%. Final visual acuity worsened (loss of 3 lines on the ETDRS chart or more) in 60%. Visual acuity was no light perception in 45.5% at the final recorded follow-up.. Demographics, clinical features and treatment outcomes of PORN in this group of Thai patients were comparable with studies from other countries. Visual prognosis is still poor with current treatment regimens.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Asian People; Disease Progression; Drug Therapy, Combination; Female; Follow-Up Studies; Ganciclovir; Humans; Injections, Intravenous; Male; Middle Aged; Prognosis; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Thailand; Treatment Outcome; Visual Acuity

Topics: Acyclovir; Antiviral Agents; DNA, Viral; Drug Therapy, Combination; Eye Infections, Viral; Foscarnet; Humans; Laser Coagulation; Polymerase Chain Reaction; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Treatment Outcome; Valacyclovir; Valine; Vitrectomy; Vitreous Body

Topics: Acyclovir; Adult; Antiviral Agents; Drug Therapy, Combination; Female; Glucocorticoids; Herpes Simplex; Herpes Zoster Ophthalmicus; Humans; Japan; Male; Middle Aged; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Scleral Buckling; Visual Acuity; Vitrectomy

To determine the viral diagnosis and factors affecting the visual outcome of eyes with acute retinal necrosis.. Nonrandomized, retrospective, interventional, noncomparative series.. A cohort of 22 human immunodeficiency virus-negative patients with acute retinal necrosis (ARN). There were 17 unilateral and 5 bilateral cases.. Diagnostic vitreous biopsy for polymerase chain reaction (PCR) viral DNA analysis, prophylactic barrier laser posterior to necrotic retina to try to prevent rhegmatogenous retinal detachment (RD), intravenous acyclovir in combination with oral, and vitrectomy for RD repair.. Results of PCR viral DNA analysis, relationship between prophylactic barrier argon laser photocoagulation and occurrence of RD, and visual acuities at presentation and follow-up.. Varicella-zoster virus (VZV) was detected in 66.7% (12/18) of eyes (66.7% of patients [10/15]) with vitreous biopsy and herpes simplex virus (HSV) in 22.2% (4/18) of eyes (20% of patients [3/15]). Epstein-Barr virus (EBV) was detected in 16.7% (3/18) of eyes (20% of patients [3/15]), and all the EBV-positive eyes were also positive for VZV. Polymerase chain reaction results were identical in both eyes of bilateral cases (5 patients) and were negative in 11.1% (2/18) of eyes (13.3% of patients [2/15]) biopsied. Systemic corticosteroid treatment given before ARN diagnosis did not appear to increase the risk of developing RD (P = 0.69). Rhegmatogenous RD occurred in 35.3% (6/17) of eyes given prophylactic argon laser treatment and in 80% (8/10) of eyes that could not be lasered prohylactically. Of RDs, 96.3% (13/14) occurred after the third week and up to 5 months from onset of symptoms. The VA after surgical repair of RD improved relative to the presentation acuity in 33.3% (4/12) of eyes.. Varicella-zoster virus is the leading cause of ARN. We recommend the management of ARN to include prompt diagnosis; prophylactic argon laser retinopexy, preferably within the first 2 weeks to reduce risk of RD; systemic acyclovir; and corticosteroids to control the severe inflammation associated with ARN. Despite the guarded visual prognosis, RD repair may result in improved visual outcomes.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Combined Modality Therapy; DNA, Viral; Epstein-Barr Virus Infections; Eye Infections, Viral; Female; Glucocorticoids; Herpes Simplex; Herpes Zoster Ophthalmicus; Herpesvirus 1, Human; Herpesvirus 2, Human; Herpesvirus 3, Human; Herpesvirus 4, Human; Humans; Laser Coagulation; Male; Middle Aged; Polymerase Chain Reaction; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Treatment Outcome; Vitrectomy; Vitreous Body

Topics: Acyclovir; Adult; Cardiolipins; Cholesterol; Drug Therapy, Combination; Fluorescein Angiography; Fluorescent Treponemal Antibody-Absorption Test; HIV Seropositivity; Humans; Male; Panuveitis; Penicillins; Phosphatidylcholines; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Syphilis

Herpes simplex virus (HSV) is a common infection that occasionally presents with destructive lesions. Two of the most feared presentations of HSV are encephalitis and acute retinal necrosis. Although there are numerous reports of acute retinal necrosis presenting after HSV-2 infection in children, it has been rarely reported in children after HSV-1 infection. Herein we report a child who developed acute retinal necrosis 17 months after HSV-1 encephalitis.

Topics: Acyclovir; Antiviral Agents; Child, Preschool; DNA, Viral; Encephalitis, Herpes Simplex; Follow-Up Studies; Herpesvirus 1, Human; Humans; Laser Therapy; Male; Polymerase Chain Reaction; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Vitrectomy

To evaluate the clinical outcome and medical management in a series of patients diagnosed with acute retinal necrosis.. Between 1993 and 2000, 22 patients suffering from acute retinal necrosis were referred to our department. We retrospectively reviewed the clinical course, delay between diagnosis and first clinical manifestation, biological profiles, treatment and complications.. All patients had vitreous inflammation; retinitis was seen upon examination in 82% of the cases. Nevertheless, for six patients (27% of the cases), failure to recognize the diagnosis led to delay (mean, 5.5 days) between the first ophthalmological examination and antiviral therapy. Nineteen patients underwent laboratory evaluation, and virological diagnosis was made in 16 of them: varicella zoster virus was found in 11 cases, herpes simplex type 1 in three cases, and herpes simplex type 2 and cytomegalovirus in one case each. Nine patients were treated with a combination of aciclovir and foscarnet and 13 with aciclovir alone. Among the 16 patients who received aciclovir, one did not respond to therapy after 2 days and was cured only after foscarnet was added. Recurrence occurred at the end of treatment in only one patient. Retinal detachment complicated the course for 11 patients and was always associated with proliferative vitreoretinopathy. Among those, seven of the ten patients who accepted surgery were successfully treated. Eleven out of 22 patients had a final visual acuity up to 20/200 and two up to 20/40.. In our series, acyclovir alone was sufficient to cure the majority of cases. Even with antiviral therapy, the prognosis of acute retinal necrosis remains poor. Retinal detachment is the main complication.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Cytomegalovirus Retinitis; Drug Therapy, Combination; Eye Infections, Viral; Female; Foscarnet; Herpes Simplex; Herpes Zoster Ophthalmicus; Humans; Infant; Male; Middle Aged; Prognosis; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Visual Acuity; Vitreoretinopathy, Proliferative

Acute retinal necrosis syndrome (ARN syndrome) is a rare viral disease with a poor prognosis in most cases. It is characterized by substantial ocular inflammation with progressive retinal necrosis, occlusive vasculitis and sometimes extraocular features.. We report the case of a 62-year-old woman who was referred for a suspicion of a stroke. Ophthalmological examination revealed a profound bilateral visual loss due to extensive retinal necrosis. The patient was immediately treated with antiherpetic drugs. ARN syndrome with meningoencephalitis caused by herpes simplex virus type 2 was confirmed by PCR studies performed on aqueous humor and cerebrospinal fluid. Herpes simplex virus 2 (IgG+ , IgM-) was probably reactivated after intrathecal injection of steroids because of pain associated with narrowing of the lumbar vertebral canal. The patient was treated with intravenous Acyclovir for 3 weeks. After 4 months, both retinas were detached.. ARN syndrome caused by herpes simplex virus 2 most often occurs after reactivation of the latent virus in patients with a neurological medical history or congenital infection. Antiviral treatment must begin early to decrease risks of bilateralization and complications.

Topics: Acyclovir; Antiviral Agents; Aqueous Humor; Cerebrospinal Fluid; Dexamethasone; Diagnostic Errors; DNA, Viral; Drug Therapy, Combination; Encephalitis, Herpes Simplex; Female; Ganciclovir; Hemiplegia; Herpesvirus 2, Human; Humans; Magnetic Resonance Imaging; Middle Aged; Polymerase Chain Reaction; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Stroke; Urinary Incontinence; Virus Activation

To report a side effect of epidural corticosteroid injections for back pain.. Case series.. Review of clinical charts and photographs.. Private retina practice.. Two patients developed acute retinal necrosis syndrome following epidural corticosteroid injections for back pain. Referral was delayed in one patient. One patient developed bilateral secondary rhegmatogenous retinal detachment, and both developed secondary macular pucker.. Acute retinal necrosis can follow epidural corticosteroid injections. Patients should be warned about this possibility and advised to report should photopsias, photosensitivity, blurred vision, or new floaters develop after treatment. Orthopedists should be aware of the complication and promptly refer patients with symptoms for dilated fundus examination by an ophthalmologist.

Topics: Acyclovir; Aged; Antibodies, Viral; Antiviral Agents; Eye Infections, Viral; Female; Glucocorticoids; Herpes Simplex; Herpes Zoster Ophthalmicus; Herpesvirus 1, Human; Herpesvirus 2, Human; Herpesvirus 3, Human; Humans; Immunoglobulin G; Injections, Epidural; Low Back Pain; Male; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Virus Activation

Topics: Acyclovir; Adolescent; Adult; Aged; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Immunosuppressive Agents; Male; Middle Aged; Recurrence; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Uveitis, Anterior

ARN syndrome follows severeintraocular infection by herpes viruses and primarily affects the peripheral retina. Following scar formation, despite antiviral treatment, rhegmatogenous retinal detachment occurs very often. Prophylactic argon laser photocoagulation has therefore been proposed. We report our experience.. We treated five patients presenting clinically with advanced unilateral ARN with acyclovir. All eyes received a prophylactic confluent double row of argon laser treatment (500 microns, 0.2 s, gray-white lesions) central to the affected area as soon as was possible, depending on the vitreous clouding. Four patients were treated with Aspirin.. One of the five patients had a peripheral rhegmatogenous retinal detachment that was limited by the argon laser row. Another patient had a tractional detachment needing vitreoretinal surgery. Two eyes developed vitreal hemorrhage of unknown origin.. A lower rate of rhegmatogenous retinal detachments than expected occurred post-laser treatment. Vitreal hemorrhage was more frequent than previously reported. The bleeding probably originated from anterior retinal neovascularization and may have been enhanced by Aspirin treatment. We recommend early prophylactic argon laser photocoagulation in all ARN patients in agreement with the results of previous studies.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Laser Coagulation; Male; Middle Aged; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Treatment Outcome

Varicella zoster virus retinitis (VZVR) in patients with AIDS, also called progressive outer retinal necrosis (PORN), is a necrotising viral retinitis which has resulted in blindness in most patients. The purposes of this study were to investigate the clinical course and visual outcome, and to determine if the choice of a systemic antiviral therapy affected the final visual outcome in patients with VZVR and AIDS.. A review of the clinical records of 20 patients with VZVR from six centres was performed. Analysis of the clinical characteristics at presentation was performed. Kruskall-Wallis non-parametric one way analysis of variance (KWAOV) of the final visual acuities of patients treated with acyclovir, ganciclovir, foscarnet, or a combination of foscarnet and ganciclovir was carried out.. Median follow up was 6 months (range 1.3-26 months). On presentation, 14 of 20 patients (70%) had bilateral disease, and 75% (15 of 20 patients) had previous or concurrent extraocular manifestations of VZV infection. Median initial and final visual acuities were 20/40 and hand movements, respectively. Of 39 eyes involved, 19 eyes (49%) were no light perception at last follow up; 27 eyes (69%) developed rhegmatogenous retinal detachments. Patients treated with combination ganciclovir and foscarnet therapy or ganciclovir alone had significantly better final visual acuity than those treated with either acyclovir or foscarnet (KWAOV: p = 0.0051).. This study represents the second largest series, the longest follow up, and the first analysis of visual outcomes based on medical therapy for AIDS patients with VZVR. Aggressive medical treatment with appropriate systemic antivirals may improve long term visual outcome in patients with VZVR. Acyclovir appears to be relatively ineffective in treating this disease.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; AIDS-Related Opportunistic Infections; Analysis of Variance; Antiviral Agents; Eye Infections, Viral; Female; Foscarnet; Ganciclovir; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Retinal Detachment; Retinitis; Retrospective Studies; Treatment Outcome; Visual Acuity

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Cytomegalovirus; Cytomegalovirus Retinitis; Drug Resistance, Microbial; Drug Therapy, Combination; Exudates and Transudates; Foscarnet; Fundus Oculi; Ganciclovir; Humans; Infusions, Intravenous; Male; Recurrence; Retinal Detachment; Visual Acuity

Progressive outer retinal necrosis is a destructive retinopathy found in patients with acquired immune deficiency syndrome. Treatment of this disorder has been unsuccessful in reported patient series, with the patients experiencing profound bilateral loss of vision.. We treated six patients with combination antiviral therapy, usually with intravenous foscarnet and either ganciclovir or acyclovir.. These six patients retained a visual acuity of 20/100 or better in at least one eye for the remainder of their lives (a period > 4 months for each patient). Retinal detachments developed in four patients, for which vitrectomy and silicone oil tamponade were required.. A combination of intravenous antiviral therapy and aggressive vitrectomy techniques to repair any associated detachments may allow the preservation of useful visual acuity in patients with progressive outer retinal necrosis. This is the first reported series of successful long-term treatment of patients with this disorder.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Female; Foscarnet; Fundus Oculi; Ganciclovir; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Infusions, Intravenous; Male; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Silicone Oils; Visual Acuity; Vitrectomy

Retinal infections caused by the varicella-zoster virus (VZV) have been reported in immunocompetent and immunocompromised individuals. Two cases of a VZV-related retinitis are described with the characteristic features of the recently described progressive outer retinal necrosis (PORN) syndrome. Both patients suffered from the acquired immunodeficiency syndrome (AIDS) with greatly reduced peripheral blood CD4+ T lymphocyte counts, and presented with macular retinitis without vitritis. The disease was bilateral in one case and unilateral in the other. The clinical course was rapidly progressive with widespread retinal involvement and the development of rhegmatogenous retinal detachment with complete loss of vision in the affected eyes despite intensive intravenous antiviral therapy. VZV DNA was identified in vitreous biopsies, by molecular techniques based on the polymerase chain reaction (PCR), in both patients. At present, the use of very high-dose intravenous acyclovir may be the best therapeutic option in these patients for whom the visual prognosis is poor. Intravitreal antiviral drugs could also contribute to the management of these cases.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; DNA, Viral; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Necrosis; Polymerase Chain Reaction; Prognosis; Retina; Retinal Detachment; Retinitis; Vitreous Body

We studied a case of acute retinal necrosis in which a 30-year delay occurred between involvement of the first and fellow eyes. After systemic treatment with acyclovir and prednisolone, the fellow eye developed a retinal detachment requiring vitrectomy and silicone oil tamponade.. The fellow eye retained a useful Snellen acuity of 20/120. In a patient who has had acute retinal necrosis, any symptoms or signs in the fellow eye, even several decades later, should alert the examining physician to the possibility of delayed involvement of the fellow eye.

Topics: Acyclovir; Eye Infections, Viral; Eyelid Diseases; Female; Herpes Simplex; Humans; Middle Aged; Prednisolone; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Silicone Oils; Time Factors; Visual Acuity; Vitrectomy

Cytomegalovirus retinopathy is the most frequent opportunistic infection of the eye in patients with acquired immunodeficiency syndrome (AIDS). We studied 71 patients with cytomegalovirus retinopathy (n = 69) or acute retinal necrosis (n = 2) with respect to the frequency and management of retinal detachment. Retinal detachment was seen in 14 patients (relative frequency, 19.7%). In 2 patients, the retinal detachment was bilateral. In 5 patients, pars plana vitrectomy and silicone-oil tamponade was performed, and in 1 of these patients scleral buckling was applied before vitrectomy. In 3 other patients scleral buckling was performed, and 1 of these individuals had sulfur-hexafluoride injection. In 8 eyes (6 patients), retinal detachment occurred in eyes with completely burned-out retinopathy without relevant function, and no surgical treatment was performed. Long-term retinal reattachment was seen in all 5 patients undergoing pars plana vitrectomy with silicone-oil tamponade. Visual acuity was preserved until the last follow-up in 4 of these 5 patients. In the patients undergoing a buckling procedure alone, no anatomic or functional success was observed. During vitrectomy, reduced retinal vascular perfusion and blood-flow sludging was observed in 2 patients. As the duration of survival of patients with AIDS and cytomegalovirus retinopathy or acute retinal necrosis is increasing, more cases of retinal detachment will be observed. Overall, 5% of patients with AIDS are expected to develop retinal detachment. In conclusion, treatment of cytomegalovirus-associated retinal detachment by pars plana vitrectomy with silicone-oil tamponade seems to be successful and safe and may maintain the patient's quality of life.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Cytomegalovirus Retinitis; Follow-Up Studies; Foscarnet; Ganciclovir; Humans; Incidence; Male; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Visual Acuity

The case is described of a male patient who had a history of acute retinal necrosis (ARN) OS at age 13 years. The eye subsequently had an inoperable retinal detachment with residual light perception visual acuity. After a 34-year disease-free interval, ARN developed OD that responded to medical treatment. This case represents the longest reported interval of ARN quiescence with eventual bilateral involvement and illustrates the importance of long-term patient follow-up.

Topics: Acyclovir; Adolescent; Adult; Aspirin; Follow-Up Studies; Humans; Infusions, Intravenous; Longitudinal Studies; Male; Prednisone; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Visual Acuity

We observed large peripheral tears of the retinal pigment epithelium in two patients, a 59-year-old man and a 15-year-old girl, who had acute retinal necrosis. These tears ranged from 90 to 180 degrees of the circumference of the peripheral retinal pigment epithelium and occurred in areas of previous retinal viral infection. Both patients had curled folds of tissue at the posterior edge of the retinal pigment epithelial tear. During vitrectomy at the time of fluid-air exchange, we noted the edge of these tears to sag posteriorly. Because of the area that was denuded of retinal pigment epithelium by the tears, we selected a more posterior location for argon laser endophotocoagulation in both patients. These large retinal pigment epithelial tears did not appear to have an adverse effect on the outcome of surgical treatment of the retinal detachments.

Topics: Acyclovir; Adolescent; Female; Humans; Male; Middle Aged; Pigment Epithelium of Eye; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Retinal Perforations; Vitrectomy

Topics: Acyclovir; Adrenal Cortex Hormones; Adult; Female; Humans; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Visual Acuity; Vitrectomy

Acute retinal necrosis (ARN) is characterized by unilateral or bilateral severe vaso-occlusive retinitis. In a large number of cases the patients become blind in the affected eyes as a direct result of the acute inflammation or the subsequent retinal detachment. The etiology is poorly understood; herpesvirus-induced vasculitis is presumed and has been demonstrated by some authors. However, the author's own investigations in seven patients show that even vitreous biopsy reveals a herpetic origin only in a minority of cases. Intravenous treatment with acyclovir and steroids prevented progression of the retinitis but did not reduce the risk of retinal detachment.

Topics: Acyclovir; Adult; Antibodies, Viral; Female; Fluorescein Angiography; Herpesvirus 3, Human; Humans; Keratitis, Dendritic; Male; Middle Aged; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Retinitis; Simplexvirus

One patient with bilateral acute retinal necrosis underwent encircling scleral buckle, vitrectomy, and intravitreal acyclovir on both eyes. This procedure was performed on the right eye while the retina was attached. The retina of the right eye was reattached by performing fluid-gas exchange and modified panretinal photocoagulation when the retina subsequently detached. Soon after the development of retinal detachment in the left eye, the above surgical procedures were performed on the left eye, and the retina was successfully reattached. Bilateral acute retinal necrosis with significant vitreous opacification, which is a devastating ocular disease causing possible blindness in both eyes, requires more aggressive, early surgical management.

Topics: Acute Disease; Acyclovir; Adult; Fundus Oculi; Humans; Light Coagulation; Male; Necrosis; Retinal Detachment; Retinal Diseases; Scleral Buckling; Syndrome; Vitrectomy

In a series of 157 patients with acquired immunodeficiency syndrome (AIDS), 46 (29%) developed cytomegalovirus (CMV) retinitis. In five patients, CMV retinitis was the initial AIDS-defining opportunistic infection (11% of patients with CMV retinitis and 3% of patients with AIDS). Retinal detachments developed in seven patients (15%) and in four were present before the institution of ganciclovir therapy. Bilateral CMV retinitis was present in 35% of patients at presentation and subsequently developed in nine (60%) of 15 patients while not being treated with ganciclovir. Conversely, none of 18 patients with unilateral disease developed bilateral disease while receiving ganciclovir. Of patients treated with ganciclovir for their CMV retinitis, 81% had a response to the drug, and 61% achieved a complete response, resulting in a nonprogressive and inactive scar. Patients who achieved a complete response with ganciclovir had a significantly longer survival than those who did not, suggesting greater immune compromise in those patients who failed to respond to ganciclovir.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adolescent; Adult; Child; Child, Preschool; Cytomegalovirus Infections; Female; Ganciclovir; Humans; Male; Middle Aged; Retinal Detachment; Retinitis; Visual Acuity

Retinal detachment (RD) occurs in more than 50% of eyes with acute retinal necrosis (ARN) and is the leading cause of visual loss in this syndrome. In order to decrease the incidence of RD in ARN, the authors treated 12 eyes of 10 patients with prophylactic laser photocoagulation. Retinal detachment occurred in two eyes (17%). Over the same time period, seven eyes with ARN did not receive prophylactic laser treatment, most often because of dense vitreous debris, with a 67% rate of RD. Prophylactic photocoagulation treatment should be considered in the management of patients with ARN.

Topics: Acute Disease; Acyclovir; Administration, Oral; Adult; Aged; Female; Humans; Injections, Intravenous; Light Coagulation; Male; Middle Aged; Necrosis; Prednisone; Retina; Retinal Detachment; Retinitis; Syndrome; Visual Acuity

Topics: Acyclovir; Cytomegalovirus Infections; Ganciclovir; Humans; Laser Therapy; Retinal Detachment; Retinal Perforations; Retinitis

Seventeen patients with the acquired immune deficiency syndrome and cytomegalovirus retinitis were treated with the antiviral drug ganciclovir (9-[1,3-dihydroxy-2-propoxy-methyl]-guanine, DHPG). Eight eyes of five patients developed rhegmatogenous retinal detachment after initiation of treatment. Multiple breaks in areas of peripheral, healed, atrophic retina accounted for the detachments. All seven eyes that underwent surgery had extensive retinal detachments that were reattached with vitrectomy and silicone oil. Retinotomy and retinal tacks were necessary in two cases that were complicated by severe proliferative vitreoretinopathy. In the fellow eye of one patient, laser treatment was used prophylactically to wall off a peripheral patch of healed retinitis. Endoretinal biopsies and culture were taken in five eyes; evidence of persistent cytomegalovirus was seen in two cases despite concurrent and clinically effective antiviral therapy.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; AIDS-Related Complex; Antiviral Agents; Biopsy; Cytomegalovirus Infections; Follow-Up Studies; Ganciclovir; Homosexuality; Humans; Male; Middle Aged; Prospective Studies; Retina; Retinal Detachment; Retinal Perforations; Retinitis; Vitrectomy

A child with bilateral cytomegalovirus (CMV) retinitis, vitritis, and exudative retinal detachments, who was in remission from stage IV neuroblastoma and status post-chemotherapy and autologous bone marrow transplantation, was treated with ganciclovir. The drug is a new acyclic nucleoside antiviral drug with potent antiCMV activity. There was bilateral retinal reattachment, clearing of vitritis and regression of retinal exudates and hemorrhages, with concomitant resolution of viral shedding in urine and blood, on ganciclovir 7.5 mg/kg per day. There was recurrence of exudative detachments, vitritis and retinitis when the dose was reduced to 2.5 mg/kg per day, and regression of these findings when the dose was again increased to 7.5 mg/kg per day. Despite continued therapy at this dose, a relapse occurred. When the dose of drug was doubled to 15 mg/kg per day, there initially was a partial therapeutic response, followed by a subsequent relapse. No further response was seen when the dose was increased to 19.5 mg/kg per day. This patient was treated with ganciclovir for a total of 192 days. No adverse reactions to ganciclovir were seen. On the last day of drug administration, there were persistent bilateral exudative retinal detachments and progressive optic nerve head involvement with optic disc pallor, despite quiescence of the retinitis.

Topics: Acyclovir; Antiviral Agents; Child, Preschool; Cytomegalovirus Infections; Exudates and Transudates; Female; Ganciclovir; Humans; Immune Tolerance; Retinal Detachment; Retinitis

We treated 13 eyes of 12 patients with the acute retinal necrosis syndrome (ARN) with intravenous acyclovir (1500 mg/M2/day) for an average of 10.9 days. All patients were also treated with oral aspirin or Coumadin. in an attempt to prevent thrombotic complications and nine of twelve patients were treated with oral prednisone after intravenous acyclovir had been initiated. Regression of retinal lesions was first seen on average 3.9 days after initiation of therapy and required 32.5 days on average for completion. No eye developed new retinal lesions or progressive optic nerve involvement 48 hours or more after initiation of therapy, although progression within the first 48 hours was occasionally seen. Treatment did not ameliorate vitritis or prevent retinal detachment, which occurred in 11 of 13 eyes, an average of 59 days after the initiation of therapy. There were no evident ocular or systemic complications of therapy. Our data suggest the need for a prospective randomized clinical trial to evaluate the efficacy of intravenous or oral acyclovir in the treatment of the acute retinal necrosis syndrome.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Child; Drug Evaluation; Female; Humans; Inflammation; Injections, Intravenous; Male; Middle Aged; Retinal Artery; Retinal Detachment; Retinal Diseases; Retinitis; Syndrome; Vision, Ocular; Vitreous Body