acyclovir and Retinal-Diseases

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Cytomegalovirus Infections; Diabetic Retinopathy; Diagnosis, Differential; Foscarnet; Ganciclovir; Humans; Phosphonoacetic Acid; Pneumonia, Pneumocystis; Prognosis; Retinal Diseases; Retinitis; Zidovudine

New therapies and diseases causing immunosuppression have provoked new and devastating ocular diseases. The possible reasons for the vulnerability of the retina to opportunistic infections are discussed. The clinical patterns of disease caused by common opportunistic agents are described, and current treatment available is reviewed.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Candidiasis; Chorioretinitis; Cytomegalovirus Infections; Eye Diseases; Herpes Simplex; Herpes Zoster; Humans; Immunity, Cellular; Immunosuppression Therapy; Infant, Newborn; Retina; Retinal Diseases; Retinal Vessels

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

We report on the case of a young immunocompetent female patient with parainfectious optic neuritis and macular inflitrate due to Neisseria meningitidis B meningitis.. Case report RESULTS: A 22-year-old female patient was admitted to the emergency department for intensive care treatment with a strong suspicion of meningitis. Clinical and serological parameters were indicative of a bacterial genesis of the meningitis. By analysis of the cerebrospinal fluid (CSF) Neisseria meningitidis type B could be detected. Subjective and objective symptoms could be improved by immediate intravenous administration of antibiotics; however, 1 day before discharge the patient complained of a sudden left-sided, painful loss of vision with extreme photophobia. The ophthalmoscopic examination revealed profound ciliary injection with slight anterior uveitis and papilledema with macular infiltration and diffuse petechiae-like retinal hemorrhage. After exclusion of viral proliferation in the CSF systemic steroid therapy was carried out together with continuation of antibiotic therapy and the eye was treated with local steroids and mydriatics. This resulted in healing of the ocular inflammation and partial recovery of vision.. The painful loss of vision in this patient is probably due to parainfectious optic neuritis with macular infiltrate from Neisseria meningitidis B meningitis, which is an unusual course. Despite the rarity of this disease the complication of a parainfectious inflammation of the optic nerve should be considered and appropriate steps taken when the corresponding symptoms occur.

Topics: Acyclovir; Adrenal Cortex Hormones; Ceftriaxone; Female; Humans; Infusions, Intravenous; Macula Lutea; Meningitis, Meningococcal; Mydriatics; Neisseria meningitidis, Serogroup B; Ophthalmic Solutions; Ophthalmoscopy; Optic Neuritis; Papilledema; Retinal Diseases; Uveitis, Anterior; Young Adult

X-linked lymphoproliferative disorder typically presents as an Epstein-Barr virus-specific immune defect with a poor prognosis. Herein we present the clinical and pathologic findings for the first known case of X-linked lymphoproliferative disorder with visual symptoms at initial presentation.. Retrospective chart review, clinicopathologic correlation (brain biopsy and postmortem brain and eye tissue), and literature review.. An 18-year-old boy had a unique presentation of X-linked lymphoproliferative disorder with visual symptoms and retinal findings. He subsequently developed central nervous system vasculitis. He never had evidence of Epstein-Barr virus infection during his clinical course, but in situ hybridization was positive in scattered cells in the brain postmortem. Eye pathologic examination at autopsy showed ischemic changes, but no inflammation.. When a young patient presents with cotton wool spots, a thorough workup must be done, and immunologic disorders should be considered in the differential diagnosis. X-linked lymphoproliferative disorder-associated eye findings may not always be associated with Epstein-Barr virus infection and, as demonstrated by this case, can be indicative of an underlying vasculitic process.

Topics: Acyclovir; Adolescent; Antiviral Agents; Diagnosis, Differential; Epstein-Barr Virus Infections; Fatal Outcome; Herpesvirus 4, Human; Humans; In Situ Hybridization; Ischemia; Lymphoproliferative Disorders; Male; Meningococcal Vaccines; Real-Time Polymerase Chain Reaction; Retinal Diseases; Retinal Vessels; Retrospective Studies; Skin Diseases, Viral; Vasculitis, Central Nervous System

To describe 3 cases of an acute zonal occult outer retinopathy-like illness responsive to valacyclovir hydrochloride.. Retrospective, interventional case series.. Three patients were treated with valacyclovir and monitored by clinical examination, Goldmann visual field testing, and electroretinography.. Patients with an acute zonal occult outer retinopathy-like illness presented following progressive vision loss. This course was immediately reversed by treatment with oral valacyclovir, and visual acuity and visual field improved significantly at 1 week and 1 month. Patients remained stable without treatment during a follow-up period ranging from 1 to 3 years.. Some conditions with features of acute zonal occult outer retinopathy may be attributable to a subacute herpetic viral infection that is responsive to oral antiviral medication.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Antiviral Agents; Electroretinography; Eye Infections, Viral; Female; Herpesviridae Infections; Humans; Male; Retinal Diseases; Retrospective Studies; Scotoma; Tomography, Optical Coherence; Valacyclovir; Valine; Visual Field Tests; Visual Fields

Typical progressive outer retinal necrosis (PORN) is an acute ocular infectious disease in acquired immunodeficiency syndrome (AIDS) patients with extremely low CD4+ T-cell counts. It is a form of the Varicella- zoster virus (VZV) infection. This destructive infection has an extremely rapid course that may lead to blindness in affected eyes within days or weeks. Attempts at its treatment have had limited success. We describe the case of a bilateral PORN in an AIDS patient with an initial CD4+ T-cell count >100 cells/microL that developed after initiation of highly active antiretroviral therapy (HAART). A 29-year-old Thai female initially diagnosed with human immunodeficiency virus (HIV) in 1998, presented with bilaterally decreased visual acuity after initiating HAART two months earlier. Multiple yellowish spots appeared in the deep retina without evidence of intraocular inflammation or retinal vasculitis. Her CD4+ T-cell count was 127 cells/microL. She was diagnosed as having PORN based on clinical features and positive VZV in the aqueous humor and vitreous by polymerase chain reaction (PCR). Despite combined treatment with intravenous acyclovir and intravitreous ganciclovir, the patient's visual acuity worsened with no light-perception in either eye. This case suggests that PORN should be included in the differential diagnosis of reduced visual acuity in AIDS patients initiating HAART with higher CD4+ T-cell counts. PORN may be a manifestation of the immune reconstitution syndrome.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiretroviral Therapy, Highly Active; Antiviral Agents; CD4 Lymphocyte Count; Female; Ganciclovir; Herpesvirus 3, Human; Humans; Necrosis; Polymerase Chain Reaction; Retina; Retinal Diseases; Thailand

Aqueous humor analysis can be performed in severe atypical forms of posterior uveitis unresponsive to conventional treatment to exclude a viral infection.. Noncomparative interventional case series.. Thirty-seven immunocompetent patients seen with corticosteroid-resistant forms of posterior uveitis underwent extensive evaluation, including anterior chamber paracentesis, to rule out a nonnecrotizing viral retinopathy.. Aqueous fluid samples were prospectively obtained. Polymerase chain reaction (PCR) and serologic evaluation of intraocular antibody production against herpesviruses were performed by molecular techniques and enzyme-linked immunosorbent assay.. Polymerase chain reaction and local antibody production for herpes simplex virus types 1 and 2, varicella-zoster virus, cytomegalovirus, and Epstein-Barr virus were determined on aqueous fluid samples.. Viral infection was confirmed in 5 cases (13.5%). Clinical presentation included birdshot-like retinochoroidopathy, occlusive bilateral vasculitis, and cystoid macular edema. An antiviral regimen was initiated in all cases. Inflammation was stabilized, and steroid dosage could be significantly reduced.. Identification of a viral agent during severe posterior uveitis can dramatically change therapeutic management.

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Antibodies, Viral; Antiviral Agents; Aqueous Humor; Diagnosis, Differential; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; Eye Infections, Viral; Female; Fluorescein Angiography; Glucocorticoids; Herpesviridae; Herpesviridae Infections; Humans; Male; Middle Aged; Polymerase Chain Reaction; Prednisone; Retinal Diseases; Uveitis, Posterior; Valacyclovir; Valine

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

A twenty-eight year old woman with necrotitizing retinitis and herpes simplex virus type 1 isolated in aqueous humor with polymerase chain reaction (PCR). An Acyclovir and corticosteroid therapy was started with unsuccessful response, Foscarnet was added getting quiescence of lesions.. Acute Retinal Necrosis Syndrome (ARNS), induced by a virus of the herpes family, could develop in immunocompetent people. A characteristic clinical case with uveitis and vitritis, white retinitis areas and occlusive vasculitis is reported. Antiviral therapy with acyclovir and antiinflammatory treatment must be established quickly. Foscarnet can effectively treat ARNS in inmunocompetent patients. In spite of therapy, this is a potentially blinding retinal disease.

Topics: Acute Disease; Acyclovir; Adult; Antiviral Agents; Diagnosis, Differential; Drug Therapy, Combination; Female; Foscarnet; Herpesvirus 1, Human; Humans; Keratitis, Herpetic; Necrosis; Polymerase Chain Reaction; Retina; Retinal Diseases; Time Factors

Topics: Acute Disease; Acyclovir; Antiviral Agents; Drug Therapy, Combination; Female; Fluorescein Angiography; Glucocorticoids; Humans; Indocyanine Green; Middle Aged; Prednisolone; Pupil Disorders; Retinal Diseases; Visual Acuity

To report retinal vasculitis in a young, immunocompetent Asian female adult with chickenpox.. Interventional case report. A 32-year-old woman had chickenpox 2 weeks before blurred vision in the left eye. The visual acuity was 20/20 for the right eye and 30/50 for the left eye. The left eye presented keratic precipitates, moderate (2+) cells in the anterior chamber and numerous cells (3+) in the vitreous. The disk was normal. Perivenous exudation was noted mainly in the inferior retina. The sheathed retinal vessels showed late staining but no remarkable leakage on fluorescein angiography. The right eye was normal.. After treatment with acyclovir for 10 days, the visual acuity in the left eye improved to 20/20, and the vasculitis resolved.. Retinal vasculitis may present as a complication of primary varicella infection in an immunocompetent adult.

Topics: Acyclovir; Adult; Antibodies, Viral; Antiviral Agents; Chickenpox; Female; Fluorescein Angiography; Herpesvirus 3, Human; Humans; Immunocompetence; Retinal Diseases; Retinal Vessels; Vasculitis; Visual Acuity

Topics: Acyclovir; Adult; Antiviral Agents; DNA, Viral; Female; Fluorescein Angiography; Genome, Viral; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Intraocular Pressure; Iridocyclitis; Male; Phlebitis; Polymerase Chain Reaction; Prednisolone; Retinal Diseases; Retinal Vein; Visual Acuity

Topics: Acyclovir; Adult; Antibodies, Viral; Antiviral Agents; Aqueous Humor; DNA, Viral; Drug Therapy, Combination; Fluorescein Angiography; Fundus Oculi; Glucocorticoids; Herpes Genitalis; Herpesvirus 2, Human; Humans; Male; Polymerase Chain Reaction; Retinal Diseases; Retinal Vessels; Vasculitis; Visual Acuity

To describe the clinical features of a disorder characterized by chronic multifocal retinal infiltrates and uveitis in individuals with human immunodeficiency virus (HIV) disease.. We reviewed the medical records of HIV-infected patients with multifocal retinal infiltrates of unknown cause seen by investigators at four institutions. The following data were collected: demographic characteristics, presenting signs and symptoms, laboratory test results, and course of disease.. We identified 26 HIV-infected patients (50 involved eyes) with this syndrome. Median CD4+ T-lymphocyte count at presentation was 272 per microl (range, 7 to 2,118 per microl). The most common presenting symptom was floaters. Median visual acuity of involved eyes at presentation was 20/20 (range, 20/15 to 20/100) and remained stable (median, 20/20; range, 20/15 to 20/70) after a median follow-up period of 9 months (range, 0 to 110 months). Typical retinal lesions were gray-white or yellow, irregular in shape, and less than 200 microm in greatest dimension. All were located in the midperiphery or anterior retina and enlarged slowly or remained static in size. Mild to moderate anterior chamber or vitreous humor inflammatory cells were present in 47 of 50 eyes (26 of 26 patients). Retinal lesions possibly responded to zidovudine but not to acyclovir or ganciclovir. Anterior chamber and vitreous humor inflammatory reactions responded to topical or periocular injections of corticosteroid.. Uveitis with chronic multifocal retinal infiltrates is a distinct clinical entity of unknown cause that occurs in HIV-infected patients. Retinal lesions may respond to antiretroviral therapy. Visual prognosis is good.

Topics: Acyclovir; Adult; Anti-HIV Agents; CD4 Lymphocyte Count; CD4-Positive T-Lymphocytes; Chronic Disease; Fundus Oculi; Ganciclovir; HIV Infections; Humans; Male; Middle Aged; Retinal Diseases; Syndrome; Uveitis; Visual Acuity; Zidovudine

A patient with AIDS who developed the clinical picture of bilateral progressive outer retinal necrosis (PORN) in combination with varicella zoster encephalitis is described. The picture developed more than 2 years after an episode of ophthalmic zoster infection, and following intermittent exposure to oral acyclovir because of recurrent episodes of cutaneous herpes simplex infection.. Aqueous humour, obtained by paracentesis of the anterior chamber, was analysed using immunofluorescence and polymerase chain reaction (PCR). Postmortem analysis of eye and brain tissue was performed by using conventional techniques and in situ hybridisation.. While conventional techniques all failed to detect a causative agent, analysis of the aqueous humour using PCR, and histological examination of necropsy specimens from eyes and brain using in situ hybridisation were conclusive for the diagnosis varicella zoster virus (VZV) infection.. This case documents the presumed association of PORN and VZV encephalitis in a severely immunocompromised AIDS patient.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Encephalitis, Viral; Herpes Simplex; Herpes Zoster; Humans; In Situ Hybridization; Male; Necrosis; Polymerase Chain Reaction; Retinal Diseases

Topics: Acyclovir; Adult; Female; Humans; Infectious Mononucleosis; Retinal Diseases

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Female; Ganciclovir; Humans; Necrosis; Retinal Diseases

Five patients with acquired immunodeficiency syndrome (AIDS) and presumed varicella-zoster virus retinopathy had recurrence of retinopathy after stabilization with initial intravenous antiviral therapy. Recurrences were recognized as increased retinal opacification at the borders of preexisting lesions or as new lesions. In four of the five patients, recurrences were temporally associated with a reduction in the amount of antiviral medication being received. Changes included switch from intravenous to oral acyclovir (two patients), taper of oral acyclovir (one patient), and discontinuation of medications (one patient). In four patients disease was initially unilateral; in three of these four, disease subsequently developed in the previously unaffected fellow eye at the time of recurrence. The median time from stabilization of disease to recurrence was 51 days (range, 14 to 90 days). In contrast to the management of varicella-zoster virus retinopathy in immunocompetent patients and varicella-zoster virus lesions of the skin, varicella-zoster virus retinopathy in patients with AIDS appears to require chronic suppressive antiviral therapy to prevent recurrences. In this respect it is similar to other opportunistic retinal infections in patients with AIDS. The best drugs and optimal treatment regimens for maintenance antiviral therapy remain unknown.

Topics: Acyclovir; Administration, Oral; Adult; AIDS-Related Opportunistic Infections; Foscarnet; Fundus Oculi; Herpes Zoster Ophthalmicus; Humans; Injections, Intravenous; Male; Recurrence; Retinal Diseases

A large percentage of patients in stage IV of HIV infection (CDC classification) show changes in the ocular fundus. Most frequent are functionally unimportant cotton-wool spots resulting from a HIV-associated microvasculopathy. Infectious retinitis due to opportunistic organisms is in most cases caused by cytomegalovirus (CMV). Untreated patients may become blind. In case of general or local treatment of cytomegalovirus retinitis with ganciclovir, sight may be preserved on a long-term basis. The ophthalmoscopic appearance of the typical changes and their histological substrate are presented, and modes of treatment are discussed. By direct ophthalmoscopy and visual acuity testing any physician can diagnose these fundus changes. Cotton-wool spots only require follow-up. In retinitis an ophthalmologist should be consulted. A screening procedure is suggested.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Chorioretinitis; Cytomegalovirus Infections; Eye Diseases; Humans; Opportunistic Infections; Retinal Diseases; Retinitis

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

The authors report two cases of patients affected by Central Serous Retinopathy (C.S.R.) lasting few days; they were immediately started with an antiviral therapy (Acycloguanosine) for few days and in both cases the regression of symptoms and a flat retina were observed after a very shorter time than the spontaneous course. A fluorescein angiography confirmed a healing of the leaking points very few days after the therapy was discontinued. The authors discuss their finding in relation to the latest hypothesis on C.S.R. pathogenesis.

Topics: Acyclovir; Adult; Fluorescein Angiography; Fundus Oculi; Humans; Male; Retinal Diseases

The authors have isolated herpes simplex virus type 1 (HSV-1) from the vitreous of two patients with acute retinal necrosis. Clinical and laboratory data suggest that one case represented a primary HSV-1 infection, whereas the other case appeared to be a recurrent HSV-1 infection. In the primary case, changes on magnetic resonance imaging (MRI) suggest spread of the virus posteriorly to both optic tracts and the lateral geniculate ganglia. This case shares many features with the "von Szily" experimental model for HSV retinitis in the mouse.

Topics: Acyclovir; Adult; Electroretinography; Fluorescein Angiography; Herpes Simplex; Humans; Magnetic Resonance Imaging; Male; Necrosis; Prednisolone; Retinal Diseases; Simplexvirus; Visual Acuity; Visual Field Tests; Visual Fields; Vitrectomy; Vitreous Body

A pregnant woman presented with acute retinal necrosis syndrome (ARNS) involving both eyes. She had had varicella eruption one month before the onset of the disease. Antibody titer to the varicella-zoster virus was elevated in the aqueous humor of both eyes. To our knowledge, this is the first report which showed apparent association of varicella eruption with ARNS caused by varicella-zoster virus.

Topics: Acyclovir; Adult; Chickenpox; Female; Fundus Oculi; Humans; Necrosis; Ophthalmoscopy; Prednisolone; Pregnancy; Pregnancy Complications; Retinal Diseases; Syndrome

Ganciclovir is an experimental antiviral drug with activity against human cytomegalovirus (CMV). Forty patients with acquired immune deficiency syndrome (AIDS) and CMV retinopathy were treated with ganciclovir on a compassionate protocol basis. Initial treatment doses ranged from 5.0 to 14.0 mg/kg/day for 9 to 26 days. Signs of drug response were a halt to enlargement of lesions, decreased opacification of retinal tissue, and resolution of hemorrhage and vasculitis. Complete response was seen in 88% of patients and incomplete response was seen in 9%. Vision improved or remained stable in 88% of patients. Initial treatment did not eradicate live virus from the eye. To prevent reactivation of disease, 26 patients received low-dose maintenance therapy ranging from 1.5 to 7.5 mg/kg/day, once or twice daily, 3 to 7 days per week. Reactivation of disease developed for unknown reasons in 50% of patients on continuous, uninterrupted maintenance therapy for longer than 3 weeks. Reversible neutropenia, requiring cessation of treatment, developed in 30% of patients on initial treatment and in 38% of patients on maintenance therapy. Rhegmatogenous retinal detachment was a late complication in seven patients. By reducing or delaying visual loss, ganciclovir appears to be useful in the management of CMV retinopathy in patients with AIDS.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Cytomegalovirus Infections; Female; Ganciclovir; Humans; Male; Middle Aged; Neutropenia; Retina; Retinal Diseases; Vision, Ocular

Ganciclovir is a new antiviral compound (also called BW B759U, DHPG, BIOLF-62, and 2'NDG) that has been used for the treatment of cytomegalovirus (CMV) retinopathy in immunocompromised patients (bone marrow recipients or acquired immune deficiency syndrome [AIDS] victims). The authors studied the eyes of three AIDS patients with CMV retinopathy who died while receiving ganciclovir chemotherapy. Gross, microscopic, and ultrastructural studies of these cases showed varying degrees of retinal scarring and active CMV lesions at the margins of the scars. CMV antigens were localized in cells at all layers of retina at the border of the lesions and in isolated cells in a perivascular location within histologically normal appearing retina. These areas probably represent sites of recrudescence when the drug is discontinued. In situ hybridization using a cloned complementary DNA (cDNA) probe of human CMV corroborated the immunocytologic localization of the virus. Ultrastructural studies showed megalic syncytial cells containing mostly capsids exclusively in the cell nucleus. The cytoplasmic electron-dense membrane-bound bodies that have characterized untreated cases of CMV retinopathy were absent in the treated cases. An attempt to isolate CMV in tissue culture from the vitreous and retina of one of the cases yielded a negative result. Our results indicate that ganciclovir does not effectively eliminate CMV from the retina nor does it suppress expression of all viral genes. Ganciclovir appears to function by limiting viral DNA synthesis and subsequent packaging of viral DNA into infectious units, thereby acting as a virostatic chemotherapeutic agent.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Cytomegalovirus; Cytomegalovirus Infections; DNA, Viral; Ganciclovir; Humans; Male; Retina; Retinal Diseases

The incidence and severity of herpes zoster ophthalmicus have increased because of the growing number of immunocompromised patients. Uveitis and keratitis are the most common inflammatory complications. Corneal exposure from scarring and contraction of the upper lid may require reconstructive plastic surgery. Preliminary studies of oral acyclovir, specifically targeted at preventing ocular complications, are encouraging.

Topics: Acyclovir; Antiviral Agents; Conjunctivitis, Viral; Eyelid Diseases; Female; Herpes Zoster Ophthalmicus; Humans; Immune Tolerance; Keratitis; Male; Orbital Diseases; Retinal Diseases; United States; Uveitis, Anterior

Topics: Acyclovir; Adult; Cytomegalovirus Infections; Deltaretrovirus Infections; Ganciclovir; Humans; Male; Middle Aged; Retinal Diseases

Topics: Acyclovir; Cytomegalovirus Infections; Ganciclovir; Humans; Retinal Diseases

Cytomegalovirus (CMV) retinopathy, a relentlessly progressive disease that results in permanent blindness, is the most common opportunistic infection of the eye in patients with the acquired immunodeficiency syndrome. Twenty patients with the acquired immunodeficiency syndrome with CMV retinopathy were treated with a new, experimental, antiviral drug, 9-[2-hydroxy-1-(hydroxymethyl)ethoxymethyl]guanine (BW B759U), in dosages ranging from 5.0 to 14.0 mg/kg/d for a ten- to 20-day course. In 19 patients (95%), treatment halted the progression of infection and decreased retinal opacification, hemorrhage, and vasculitis. Vision remained stable in most cases. Six patients received no additional treatment. Fourteen patients received continued treatment with a lower maintenance dosage. Retinal disease reactivated in all patients who did not receive maintenance therapy immediately after initial treatment, indicating persistence of live virus despite drug therapy. Reactivation of disease also developed in four (40%) of ten patients receiving continuous, uninterrupted maintenance therapy for longer than three weeks. Reversible neutropenia, requiring cessation of treatment, developed in five (25%) of 20 patients on initial treatment and five (36%) of 14 patients receiving maintenance therapy. Rhegmatogenous retinal detachment was a late complication in four patients. BW B759U appears to be useful in the management of CMV retinopathy by reducing or delaying visual loss.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Cytomegalovirus Infections; Drug Evaluation; Ganciclovir; Humans; Male; Middle Aged; Neutropenia; Retinal Diseases; Visual Acuity

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

Two patients with acute retinal necrosis were treated with vitrectomy, intravitreal infusion of acyclovir, and prophylactic scleral buckling procedures. Both patients have had a uneventful postoperative course and a recovery of visual acuity; follow-up has been at five and 14 months. There has been no sign of toxicity from the intravitreally administered acyclovir by electroretinographic or clinical criteria.

Topics: Acute Disease; Acyclovir; Adolescent; Female; Humans; Male; Middle Aged; Necrosis; Retina; Retinal Diseases; Scleral Buckling; Syndrome; Vitrectomy; Vitreous Body