acyclovir and Retinal-Perforations

Keratitis occurring in renal transplant patients are often severe, with difficult management. We describe the case of a renal transplant patient, 44 year-old man, with history of recurrent herpetic keratitis, which developed an impending corneal perforation. Conjunctival smear showed the presence of amoebic cysts. Anti-amoebic treatment was undertaken in addition with oral aciclovir, and a therapeutic penetrating keratoplasty was performed. An ulceration of the graft occurred within five months. Ocular samples showed the presence of Candida albicans. Despite aggressive antifungal therapy, he required a second therapeutic penetrating keratoplasty for graft perforation. One month later, we noted a recurrence of the ulcer with corneal thinning which evolved to perforation.

Topics: Acyclovir; Adult; Amebiasis; Animals; Antifungal Agents; Candida albicans; Conjunctiva; Corneal Transplantation; Humans; Keratitis, Herpetic; Kidney Transplantation; Male; Recurrence; Retinal Perforations

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; 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