acyclovir and Retinitis

Varicella zoster virus (VZV) ocular infection can manifest purely as a vasculopathy that leads to retinal arteriole occlusion, without any retinitis or vasculitis. This review summarizes our current knowledge of such VZV ocular infection phenotype, incorporating initial descriptions from 1988. We describe the pathogenesis and VZV's manifestations in the retina using fundus photography, fundus fluorescein angiography, optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Laboratory investigations, diagnostic procedures, prognoses, and treatment options are also being reviewed.. Ten case reports where VZV retinal vasculopathy was the primary feature observed after varicella or zoster rash are described. The retinal arteriole, cilioretinal artery, branches of retinal artery, central retinal artery and ophthalmic artery were found to be areas of more rarely affected, neither in the form of vasculitis nor retinitis. Diagnosis is typically made from positive polymerase chain reaction (PCR) for VZV from extracted intraocular fluid or positive serum or cerebrospinal fluid (CSF) anti-VZV immunoglobulin G antibody in the context of compatible ocular findings. In addition, retinal vasculopathy occurring in the setting of confirmed varicella or zoster rashes could be considered potentially pathognomonic. Pathological concepts, including direct VZV infection of affected tissue, persistent inflammation, and/or virus-induced hypercoagulability are also discussed.. VZV may produce a wide spectrum of ocular manifestations with isolated VZV retinal vasculopathy being a rarer presentation. A prompt diagnosis followed by an early treatment of systemic acyclovir with or without corticosteroids is the mainstay of treatment.

Topics: Acyclovir; Chickenpox; Eye Infections; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunoglobulin G; Retinitis; Vasculitis

Serious ocular disease following varicella (chickenpox) is rare in children. In addition, retinitis in children with hematologic malignancies may present a difficult diagnostic challenge because infectious retinitis may mimic leukemic involvement of the eye. We report a 7-year-old patient with T-cell acute lymphoblastic leukemia in remission who presented with visual complaints 2 weeks after developing chickenpox. Ophthalmologic evaluation revealed acute retinitis in the right eye. Prolonged therapy with acyclovir resulted in near complete recovery. Early diagnosis of VZV retinopathy and aggressive antiviral treatment is critical to prevent acute and long-term ocular sequelae.

Topics: Acyclovir; Antiviral Agents; Chickenpox; Chickenpox Vaccine; Child; Diagnosis, Differential; Humans; Leukemia, T-Cell; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Retinitis

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

Topics: Acquired Immunodeficiency Syndrome; Acute Disease; Acyclovir; Chorioretinitis; Cytomegalovirus Infections; Diagnosis, Differential; Ganciclovir; Herpes Zoster Ophthalmicus; Humans; Keratitis, Dendritic; Light Coagulation; Mycoses; Necrosis; Opportunistic Infections; Retina; Retinitis; Syphilis; Toxoplasmosis

CMV disease is a major problem in AIDS, though with a different profile from that seen in other immunosuppressed patients. The novel treatments, ganciclovir and phosphonoformate, have a major role in the management of such infections, but maintenance therapy is often required. Optimal maintenance regimens have yet to be established, especially where zidovudine is also being used.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Addison Disease; Antiviral Agents; Colitis; Cytomegalovirus Infections; Encephalitis; Esophageal Diseases; Foscarnet; Ganciclovir; Humans; Phosphonoacetic Acid; Pneumonia, Viral; Retinitis

Life-threatening opportunistic cytomegalovirus infection is a complication of the acquired immunodeficiency syndrome (AIDS) that occurs in 7.4% or more of patients with AIDS. Cytomegalovirus retinitis, colitis, esophagitis, and gastritis are the commonest manifestations of severe cytomegalovirus end-organ disease. Extensive trials with intravenous ganciclovir, a nucleoside analogue with myelosuppressive toxicity, have shown that ganciclovir halts the progression of cytomegalovirus retinitis and gastrointestinal disease. Since relapse is common when therapy is discontinued, most patients with AIDS need life-long maintenance therapy. The clinical response to ganciclovir therapy is usually accompanied by diminished shedding of the virus. Based on limited data, foscarnet, a pyrophosphate analogue, also appears to have some efficacy in treating cytomegalovirus infection. Unlike ganciclovir, foscarnet does not cause myelosuppression. An important direction for future clinical research is the development of more effective and less toxic therapy, as well as orally bioavailable drugs for maintenance therapy.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Foscarnet; Ganciclovir; Gastroenteritis; Humans; Opportunistic Infections; Phosphonoacetic Acid; Pneumonia, Viral; Retinitis

Immunosuppressed patients are at risk for developing cytomegalovirus retinitis. This disorder is the most common cause of vision loss in patients with the acquired immunodeficiency syndrome (AIDS). Cytomegalovirus retinitis is probably the result of hematogenous spread of the virus to the retina after systemic reactivation of a latent cytomegalovirus infection. Although the ophthalmic infection may initially be asymptomatic, the retinal necrosis it produces may result in both loss of visual field and decreased visual acuity. Routine screening of these patients is required for early diagnosis. The retinitis is detected with ophthalmoscopy as either a perivascular yellow-white retinal lesion frequently associated with retinal hemorrhage or as a focal white granular infiltrate, often without hemorrhage. Both lesions enlarge in a progressively expanding "brushfire" pattern. The diagnosis of cytomegalovirus retinitis, as well as the evaluation of its response to therapy, is determined primarily by clinical criteria. Serial retinal photography is an objective method to assess the changing appearance of these lesions. Ganciclovir and foscarnet are investigational antiviral drugs that appear to be effective in treating cytomegalovirus retinitis. However, maintenance therapy with these medications is required after initial treatment because the disease often relapses. The combined expertise of the internist and the ophthalmologist is needed to diagnose and treat these patients.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Diagnosis, Differential; Foscarnet; Fundus Oculi; Ganciclovir; Humans; Opportunistic Infections; Phosphonoacetic Acid; Retinitis; Vision Disorders

Cytomegalovirus, herpes simplex, and herpes zoster are responsible for the majority of cases of viral retinitis. Herpes zoster also has been strongly incriminated as a causal agent in acute retinal necrosis. Effective chemotherapy exists for retinitis caused by herpes simplex and herpes zoster, along with acute retinal necrosis. Conventional antiviral therapy and immunomodulators are ineffective in the treatment of cytomegalovirus retinitis in patients with acquired immune deficiency disorder. Ganciclovir, a new antiviral agent, has significantly reduced visual morbidity in these patients. Recurrence of the infection is not uncommon while patients are on the drug or when the agent is discontinued, because ganciclovir is virostatic and does not stop viral replication in the retina. The inability to control this viral retinitis using presently available chemotherapy indicates a need to examine other therapeutic modalities.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Cytomegalovirus Infections; Ganciclovir; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Humans; Retinitis

To evaluate the efficacy and safety of high-dose intravenous acyclovir combined with oral zidovudine as suppressive therapy for cytomegalovirus retinitis in patients with AIDS, a single-arm, outpatient, open-label, phase II pilot study was performed. Between July 1989 and July 1990, 12 men with AIDS, cytomegalovirus retinitis, and salvageable vision received intravenous acyclovir, 10 mg/kg of body weight every 8 h, and oral zidovudine after successful induction therapy with intravenous ganciclovir, 5 mg/kg every 12 h for 14 days. Patients were evaluated weekly. Ten of 12 patients were followed to the time of retinitis progression; two were withdrawn from the study because of concomitant life-threatening infection. The median duration of acyclovir and zidovudine therapy before retinitis progression occurred was 32 days. None of the eight uninvolved eyes in the 10 evaluatable patients developed cytomegalovirus retinitis during study participation. These data suggest that high-dose intravenous acyclovir with zidovudine provides some benefit in suppressing cytomegalovirus retinitis.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Administration, Oral; Adult; Cytomegalovirus Infections; Drug Evaluation; Drug Therapy, Combination; Eye Infections, Viral; Follow-Up Studies; Humans; Injections, Intravenous; Male; Middle Aged; Ophthalmoscopy; Pilot Projects; Retinitis; Zidovudine

We report the first randomized prospective comparative study of long-term maintenance ganciclovir (9-[2-hydroxy-1-(hydroxymethyl)ethoxymethyl]guanine, BW759U, DHPG) therapy for cytomegalovirus retinitis in patients with the acquired immunodeficiency syndrome (AIDS). Eleven retinitis patients who received a 10-day course of ganciclovir induction therapy and then were randomized to receive either immediate daily ganciclovir maintenance therapy or deferred maintenance (eight deferred maintenance, three immediate maintenance) were evaluated for drug efficacy. Median time to retinitis progression was 42 days for the immediate maintenance group compared with 16 days for the deferred maintenance group, (P = 0.07). After crossing over to maintenance therapy, patients in the deferred group had a median time to retinitis progression of 58 days compared to 16 days while not on maintenance therapy (P = 0.13). Only 9% of cultures obtained while patients received maintenance therapy were positive for cytomegalovirus, vs 40% of those obtained off maintenance (P less than 0.001). We can state then that maintenance therapy with ganciclovir delays, but does not halt, progression of cytomegalovirus retinitis and suppresses, but does not eradicate, cytomegalovirus shedding in patients with AIDS.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Clinical Trials as Topic; Cytomegalovirus; Cytomegalovirus Infections; Ganciclovir; Humans; Middle Aged; Prospective Studies; Random Allocation; Retinitis

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 the first case of varicella zoster virus (VZV) retinitis following chimeric antigenic response (CAR) T-cell therapy.. Case review.. A 53-year-old male was treated with CAR T-cell therapy for refractory diffuse large B-cell lymphoma. Nine months after CAR T-cell therapy, he developed VZV skin infection and retinitis. The retinitis responded to systemic acyclovir therapy and intravitreal ganciclovir.. VZV retinitis can occur following CAR T-cell immunotherapy.

Topics: Acyclovir; Cell- and Tissue-Based Therapy; Chickenpox; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Lymphoma, B-Cell; Male; Middle Aged; Retinitis

A 10-year-old boy underwent stem cell transplant for Hodgkin's lymphoma and developed vomiting and seizure in the postoperative period. An ophthalmic referral was made from intensive care unit, to rule out papilledema. On examination, there was no papilledema in both eyes, instead there were areas of retinal necrosis with no haemorrhages or vitritis in right eye. Cerebrospinal fluid serology was negative for herpes but MRI showed hyperintensity in temporal lobe. A clinical diagnosis of progressive outer retinal necrosis (PORN) was made and fundus picture was documented with help of a smartphone and 20D lens. High-dose intravenous injection acyclovir was started and PORN lesion improved on treatment.

Topics: Acyclovir; Antiviral Agents; Bone Marrow Transplantation; Child; Diagnosis, Differential; Dose-Response Relationship, Drug; Herpesviridae Infections; Hodgkin Disease; Humans; Immunosuppressive Agents; Incidental Findings; Magnetic Resonance Imaging; Male; Necrosis; Retina; Retinal Necrosis Syndrome, Acute; Retinitis; Treatment Outcome; Virus Activation

Topics: Acyclovir; Antiviral Agents; Herpes Simplex; Humans; Retinitis; Simplexvirus

Other than well-known herpetic retinopathies like acute retinal necrosis, progressive outer retinal necrosis and cytomegalovirus retinitis, there are few reports on atypical forms of viral retinitis caused by herpes virus from around the world.. Presenting symptom was sudden onset of diminution of vision in all 6 cases. Mean duration of symptoms at presentation was 7.6 days. The mean age was 27.3 years (range 22-40 years). All were immunocompetent (4 females and 2 males), with unremarkable review of system. All had unilateral involvement. Presenting visual acuity ranged from CFCF to 6/60. Granulomatous anterior uveitis was present in 4 cases. All had focal retinitis with irregular margins, either juxtapapillary, macular or over one of the major vascular arcades. The diagnosis of focal viral retinitis was made solely based upon the clinical findings. All recovered after a course of oral acyclovir (one was given additional intravitreal acyclovir as well) and oral prednisolone, with final visual acuity of 6/6P to 6/9 in all except one.. In case of focal retinitis with irregular margin, viral etiology should be borne in mind. Clinical features are typical enough to help in diagnosing without PCR test.

Topics: Acyclovir; Adult; Antiviral Agents; Eye Infections, Viral; Female; Humans; Male; Retinal Necrosis Syndrome, Acute; Retinitis; Young Adult

To describe atypical varicella zoster virus (VZV) retinitis in a patient with Good syndrome.. A 63-year-old patient with Good syndrome presented with bilateral necrotizing retinitis starting from the posterior pole. He had a history of thymoma status post thymectomy 4 years previously, left-sided sinusitis, and recent pulmonary aspergillosis. Qualitative PCR was performed on aqueous fluid.. Immunological investigations revealed reduced levels of CD4. Good syndrome should be considered in a patient with opportunistic infections and history of thymoma in the absence of human immunodeficiency virus. Atypical retinitis can occur in patients with Good syndrome and quantitative PCR is important for accurate diagnosis.

Topics: Acyclovir; Agammaglobulinemia; Antiviral Agents; Aqueous Humor; CD4 Lymphocyte Count; DNA, Viral; Eye Infections, Viral; Fluorescein Angiography; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Middle Aged; Polymerase Chain Reaction; Retinitis; Thymoma; Thymus Neoplasms; Valacyclovir; Valine; Visual Acuity

Acute retinal necrosis (ARN) is a feared complication of infectious retinitis most commonly caused by varicella zoster virus (VZV). We performed a pharmacokinetic modeling and simulation study by integrating the existing understanding of physiology with previously published data to evaluate the vitreal penetration of oral valacyclovir for the treatment of ARN, under various dosing scenarios.. We compared different oral valacyclovir dosing regimens with intravenous acyclovir. The vitreous compartment was modeled as a peripheral compartment, and paired serum and vitreal acyclovir concentrations were obtained from previously published data of adult patients with ARN undergoing vitrectomy. The efficacy threshold for vitreal acyclovir concentrations was based on the previously reported IC. Based on the minimum vitreal acyclovir concentrations (C. Modeling and simulation data support oral valacyclovir for the treatment of ARN, although the required dosing exceeds the recommended FDA dose size for herpes zoster.

Topics: Acyclovir; Antiviral Agents; Computer Simulation; Dose-Response Relationship, Drug; Drug Administration Routes; Herpesvirus 3, Human; Humans; Models, Theoretical; Retinal Necrosis Syndrome, Acute; Retinitis; Valacyclovir; Valine; Varicella Zoster Virus Infection; Vitreous Body

The increasing incidence of aciclovir- (ACV) resistant strains in patients with ocular herpes simplex virus (HSV) infections is a major health problem in industrialized countries. In the present study, the humanized monoclonal antibody (mAb) hu2c targeting the HSV-1/2 glycoprotein B was examined for its efficacy towards ACV-resistant infections of the eye in the mouse model of acute retinal necrosis (ARN). BALB/c mice were infected by microinjection of an ACV-resistant clinical isolate into the anterior eye chamber to induce ARN and systemically treated with mAb hu2c at 24h prior (pre-exposure prophylaxis) or at 24, 40, and 56h after infection (post-exposure immunotherapy). Mock treated controls and ACV-treated mice showed pronounced retinal damage. Mice treated with mAb hu2c were almost completely protected from developing ARN. In conclusion, mAb hu2c may become a reliable therapeutic option for drug/ACV-resistant ocular HSV infections in humans in order to prevent blindness.

Topics: Acyclovir; Animals; Antibodies, Monoclonal; Antibodies, Viral; Antiviral Agents; Drug Resistance, Viral; Female; Herpesviridae; Humans; Immunotherapy; Mice; Mice, Inbred BALB C; Retinitis

To determine the role of intravitreal triamcinolone acetonide (IVTA) as an adjuvant in the management of acute retinal necrosis (ARN).. Interventional case series.. Four eyes of 4 patients diagnosed with ARN were studied.. This pilot case series included 4 patients who presented with clinical features suggestive of ARN. IVTA was injected 1 to 2 weeks after initiation of antiviral therapy and concurrent usage of oral corticosteroids. The disease course and clinical outcome were observed. The patients received additional treatment depending on the sequelae of ARN.. Signs of reduction in vitritis and resolution of retinitis were observed as early as 1 week after IVTA was administered. In all 4 patients, inflammation promptly resolved with no untoward effects like raised intraocular pressure or worsening of the retinitis. A final visual acuity of 20/40 or better was achieved in 3 of 4 patients after appropriate treatment of ARN-related complications.. Intravitreal triamcinolone under antiviral cover could be a useful adjunct to systemic steroids in the treatment of ARN.

Topics: Acyclovir; Adolescent; Antiviral Agents; Chemotherapy, Adjuvant; Eye Diseases; Female; Glucocorticoids; Humans; Intravitreal Injections; Male; Middle Aged; Pilot Projects; Retinal Necrosis Syndrome, Acute; Retinitis; Triamcinolone Acetonide; Valacyclovir; Valine; Visual Acuity; Vitreous Body; Young Adult

Acute retinal necrosis, caused by the herpes family of viruses, is a rapidly progressing ocular inflammatory disorder commonly reported in adults but rarely in children. The accepted diagnostic criteria include presence of 1 or more foci of retinal necrosis, rapid progression, circumferential spread, occlusive vasculopathy, and inflammation in the vitreous and anterior chamber. We report bilateral acute retinal necrosis with encephalitis due to herpes simplex virus (HSV-2) in newborn twins.

Topics: Acute Disease; Acyclovir; Adult; Antiviral Agents; Encephalitis, Herpes Simplex; Herpes Genitalis; Herpesvirus 2, Human; Humans; Infant, Newborn; Infant, Premature; Infectious Disease Transmission, Vertical; Male; Necrosis; Retinitis; Twins

To report ocular manifestations associated with chikungunya.. Retrospective, nonrandomized, observational case series.. Nine chikungunya patients with ocular involvement.. All patients with chikungunya infection presenting with ocular complaints from September 2006 to October 2006 were included in the study. The infection was confirmed by demonstration of chikungunya immunoglobulin M antibody in sera of all patients. All patients underwent an ophthalmic examination including fundus photography, fundus fluorescein angiography, confocal microscopy of keratic precipitates, and optical coherence tomography. Positive ocular changes were recorded and tabulated.. Characteristics, frequency, and locations of ocular lesions found in the participants.. There were 9 patients with ocular lesions; 1 had nodular episcleritis, 5 presented with acute iridocyclitis, and 3 had retinitis. Four to 12 weeks before the development of ocular manifestations, all of these patients had fever. Although there were no specific changes of iridocyclitis that were diagnostic of the fever, the retinal changes were consistent with viral retinitis. All patients recovered from the infection with relatively good vision.. It appears that iridocyclitis and retinitis are the most common ocular manifestations associated with chikungunya, with a typically benign clinical course. Less frequent ocular lesions include episcleritis. All the patients responded well to the treatment with preservation of good vision. To the best of our knowledge, similar ocular manifestations associated with chikungunya infection have not been reported. In the differential diagnosis of iridocyclitis and retinitis with features suggestive of a viral infection, the entity of chikungunya-associated ocular changes should be considered in the regions affected by the epidemic.

Topics: Acyclovir; Adult; Aged; Alphavirus Infections; Antibodies, Viral; Antiviral Agents; Chikungunya virus; Diclofenac; Drug Therapy, Combination; Eye Infections, Viral; Female; Fluorescein Angiography; Humans; Immunoglobulin M; Iridocyclitis; Male; Microscopy, Confocal; Middle Aged; Prednisolone; Retinitis; Retrospective Studies; Scleritis; Tomography, Optical Coherence; Visual Acuity

Topics: Acyclovir; Administration, Oral; Anemia, Refractory, with Excess of Blasts; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Cytarabine; DNA, Viral; Eye Infections, Viral; Granulocyte Colony-Stimulating Factor; Herpesvirus 3, Human; Humans; Male; Middle Aged; Retinitis; Stem Cell Transplantation; Transplantation, Homologous; Valacyclovir; Valine; Vidarabine

To report the use of intravenous (IV) antiviral agents and intravitreal ganciclovir injections in three immunocompetent patients with severe acute retinal necrosis (ARN).. Case series.. Three immunocompetent patients, who had lost vision in the first eye due to ARN, received intensive treatment with IV foscarnet or acyclovir or ganciclovir and intravitreal ganciclovir injections for the treatment of severe ARN involving the fellow eye. The retinitis resolved and final visual acuity of the fellow eye improved to 20/20 in all three cases after a mean follow-up of 17 months.. Intensive treatment with a combination of two intravenous antiviral drugs and intravitreal ganciclovir injections was successful in the management of patients with acyclovir-resistant ARN and monocular status.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Drug Therapy, Combination; Female; Foscarnet; Ganciclovir; Herpes Zoster Ophthalmicus; Humans; Injections; Male; Necrosis; Retinitis; Severity of Illness Index; Visual Acuity; Vitreous Body

It is usual to consider chicken pox as a benign infectious disease with a few anterior segment ocular complications like conjunctivitis, keratitis, episcleritis, scleritis, iridocyclitis, and glaucoma. The retinal manifestations are necrotising retinitis, vitritis, neuroretinitis, and retinal detachments. We report a case of neuroretinitis following chicken pox in a 23-year-old male. The complication was resolved by treatment with oral acyclovir in combination with systemic steroids. This report highlights the necessity for fundus examination in cases of chickenpox exhibiting visual symptoms.

Topics: Acyclovir; Administration, Oral; Adult; Antiviral Agents; Chickenpox; Drug Therapy, Combination; Eye Infections, Viral; Glucocorticoids; Humans; Male; Prednisolone; Retinitis

Topics: Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Chickenpox; Child; Humans; Male; Prednisolone; Retinitis; Vision Disorders; Visual Acuity

Infections with varicella zoster virus may involve the optic nerve and the retina. Different pathomechanisms have been discussed. We present a case with an autoimmune inflammatory reaction according to the clinical course.. A 69-year-old female was referred to our clinic because of suspected bilateral anterior ischemic optic neuropathy. She complained of severe visual loss the day before admission. Her ophthalmological and general history was unremarkable apart from treatment with 5 to 7.5 mg prednisolone alternately because of rheumatoid arthritis. Best corrected visual acuity was 1/15 OD and 0.1 OS. A relative afferent pupillary defect on the right eye was present. Optic disc oedema with multiple hemorrhages of the retina extending into the peripheral funds, slightly attenuated retinal arteries and macular oedema were seen fundoscopically in both eyes. THERAPY AND CLINICAL OUTCOME: After immediate treatment with steroids (initial dose 250 mg prednisolone per day) visual acuity improved. Because of a clinically suspected and serologically proven active varicella-zoster infection an additional virostatic therapy with valaciclovir was started and steroids were lowered gradually. Within 2 months, visual acuity increased to 0.8 OD and 1.0 OS. Oedema of optic discs and macula resolved and retinal hemorrhages disappeared.. A severe hemorrhagic neuro-retinitis involving the optic discs was seen in the course of a varicella-zoster infection, possibly reactivated by chronic steroid therapy of a rheumatoid arthritis. Because of the normalization of visual function an ischemic pathogenesis is unlikely. An autoimmune inflammatory reaction seems to be the predominant mechanism, supported by the good effect of steroid and valaciclovir therapy.

Topics: Acyclovir; Aged; Antiviral Agents; Diagnosis, Differential; Female; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Optic Nerve; Papilledema; Prednisolone; Retinitis; Valacyclovir; Valine

This study aimed to describe a recently recognized and rare presentation of varicella zoster virus (VZV) retrobulbar optic neuritis preceding retinitis in patients with acquired immune deficiency syndrome and to identify factors that may relate to improved visual outcome.. Diagnosis, treatment, and clinical course are described for three eyes of two patients with this viral infection.. Patients had decreased vision, headache, and recent zoster dermatitis. Varicella zoster virus retrobulbar optic neuritis was diagnosed on the bases of clinical, laboratory, and electrophysiologic examination results. Profound vision loss and peripheral retinitis ensued despite intravenous antiviral treatment. Combination intravenous and intravitreous antiviral injections were administered with dramatic visual recovery.. Varicella zoster virus retrobulbar optic neuritis should be considered in immunocompromised patients with visual loss. Early diagnosis and aggressive combination therapy via systemic and intravitreous routes may enable return of useful vision.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Cerebrospinal Fluid; Female; Foscarnet; Fundus Oculi; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Meningitis, Viral; Optic Neuritis; Orbital Diseases; Retinitis; Skin Diseases, Viral; Visual Acuity

A case of recurrent unilateral varicella-zoster virus (VZV) retinitis is reported. The retinitis was characterized by arteriolitis and retinal necrosis with secondary chorioretinal atrophy localized in the periphery of the supratemporal quadrant of the retina. Polymerase chain reaction analysis of aqueous humor demonstrated VZV DNA in both the initial and recurrent episode. The Goldmann-Witmer coefficient for VZV IgG was elevated. The initial VZV retinitis was successfully treated with acyclovir and corticosteroids. Three years later, high-dose corticosteroids alone were used to treat idiopathic facial nerve palsy. One month after concluding corticosteroids therapy, the VZV retinitis recurred in the same eye, suggesting that administration of the high-dose corticosteroids caused VZV reactivation and induced recurrence of VZV retinitis.

Topics: Acyclovir; Adult; Antibodies, Viral; Aqueous Humor; DNA, Viral; Drug Therapy, Combination; Facial Paralysis; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Polymerase Chain Reaction; Prednisolone; Recurrence; Retinal Necrosis Syndrome, Acute; Retinitis; Virus Activation

Acyclovir diphosphate dimyristoylglycerol is a lipid prodrug of acyclovir that forms liposomes and provides substantial activity against herpes simplex virus, acyclovir-resistant strains of herpes simplex virus, and human cytomegalovirus. We therefore tested this promising new drug in a rabbit model of herpes simplex retinitis.. A total of 22 pigmented rabbits were pretreated with either acyclovir diphosphate dimyristoylglycerol, ganciclovir, acyclovir, or buffer. Retinae then were inoculated with herpes simplex virus-1 or buffer 1 week after the injection of drug. In another experiment we compared the effects of acyclovir diphosphate dimyristoylglycerol and acyclovir diphosphate dioleoylglycerol on the optical clarity of vitreous.. Animals injected intravitreally with acyclovir diphosphate dimyristoylglycerol showed retinitis that was less severe than that in animals injected with ganciclovir, acyclovir, and buffer; differences in grading scores of the retinitis between animals injected with acyclovir diphosphate dimyristoylglycerol and those injected with buffer were statistically significant (P = 0.0015). Vitreous and optical media became clear 4 days after acyclovir diphosphate dioleoylglycerol injection compared with 10 days after with acyclovir diphosphate dimyristoylglycerol injections.. Acyclovir diphosphate dimyristoylglycerol had prolonged antiviral activity against herpes simplex virus-1 retinitis in a rabbit model. This drug delivery system, modified to improve optical clarity, may allow long-acting intravitreal treatment of cytomegalovirus retinitis and other retinal diseases.

Topics: Acyclovir; Animals; Antiviral Agents; Disease Models, Animal; Ganciclovir; Herpes Simplex; Liposomes; Phosphatidylglycerols; Prodrugs; Rabbits; Retinitis; Simplexvirus; Virus Replication

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

To describe a case of retinal perivasculitis in an immunocompetent patient with systemic herpes simplex infection.. Polymerase chain reaction amplifications were performed for aqueous and blood samples using primers specific for the following members of the herpesvirus family: cytomegalovirus, Epstein-Barr virus, herpes simplex virus (types 1 and 2), and varicella-zoster virus. The patient was placed on intravenous acyclovir and systemic corticosteroids.. A positive polymerase chain reaction signal was found only for herpes simplex virus type 1. Vision in the left eye improved from light perception to 20/25, and signs of retinal perivasculitis resolved.. The use of molecular diagnostic modalities in clinical practice may aid in determining infectious etiologies in patients with atypical clinical manifestations.

Topics: Acyclovir; Antiviral Agents; Aqueous Humor; DNA, Viral; Eye Infections, Viral; Female; Fluorescein Angiography; Fundus Oculi; Herpes Simplex; Herpesvirus 1, Human; Humans; Immunocompetence; Middle Aged; Polymerase Chain Reaction; Retinal Vein; Retinitis; Vasculitis; Viremia

Topics: Acyclovir; Adult; Anti-Inflammatory Agents; Antiviral Agents; Drug Therapy, Combination; Female; Herpes Zoster Ophthalmicus; Humans; Optic Neuritis; Prednisolone; Retinitis

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 examined an immunocompetent patient with uniocular acute progressive outer retinitis. The retinitis was curvilinear in shape, showed progressive enlargement, and appeared to be altered by treatment with intravenous acyclovir. When regressed, the affected area of retina appeared atrophic and, at one-year follow-up, demonstrated intraretinal pigment migration with retinal pigment epithelial atrophy and atrophy of the choriocapillaris. Although visual acuity was unaffected, a dense scotoma was recorded on field testing. The response to acyclovir implicates the herpesvirus family, and acyclovir or another antiherpetic agent should be considered for such cases.

Topics: Acyclovir; Adult; Atrophy; Female; Humans; Immunocompetence; Recurrence; Retinitis

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Cerebrovascular Disorders; Female; Herpes Zoster; Humans; Male; Middle Aged; Necrosis; Retinitis; Vasculitis

Acute retinal necrosis (ARN) is generally a progressive retinitis, often complicated by retinal detachment and a poor visual outcome. A series of 12 consecutive patients (13 eyes) with ARN is reported. All patients were examined early, with a limited extent of disease (in 77% of the eyes, less than 25% of retina involved). Patients were treated with high-dose intravenous acyclovir (10 mg/kg every 8 hours) and laser photocoagulation. During a follow-up period of 3 to 21 months, only 1 patient developed a rhegmatogenous retinal detachment resulting in visual loss. No patients developed bilateral disease once intravenous antiviral therapy was begun. Final visual acuity was 20/40 or better in 6 eyes (46%), and 20/400 or better in 12 eyes (92%). Two patients were examined within 6 weeks of extracapsular cataract extraction with intraocular lens implantation. In the majority of the cases, clinical findings were limited to several quadrants of the peripheral retina. Eyes with limited disease, if aggressively treated, have a relatively good visual prognosis.

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Infusions, Intravenous; Laser Coagulation; Male; Middle Aged; Prognosis; Retinal Necrosis Syndrome, Acute; Retinitis; Vision Disorders; Vision, Ocular; Visual Acuity

A 31-year-old woman with systemic lupus erythematosus (SLE) developed meningoencephalitis, followed by transverse myelitis. The clinical picture was otherwise not consistent with a lupus flare. Extensive diagnostic evaluation was unrevealing. Acute visual loss ensued, associated with an unusual pattern of retinitis. Endoretinal biopsy established the diagnosis of herpesvirus infection. Reinstitution of antiviral therapy, and optic nerve sheath decompression, led to resolution of neurologic deficits and partial return of vision. Our report is the first that describes a patient with SLE with herpes meningoencephalitis, transverse myelitis, and rapidly progressive outer retinal necrosis, diagnosed antemortem by endoretinal biopsy, and successfully treated with acyclovir and optic nerve fenestration.

Topics: Acyclovir; Adult; Biopsy; Central Nervous System Diseases; Combined Modality Therapy; Female; Herpesviridae Infections; Humans; Lupus Erythematosus, Systemic; Meningoencephalitis; Myelitis, Transverse; Opportunistic Infections; Retinitis

A 38-year-old bisexual man with acquired immunodeficiency syndrome (AIDS) who was being treated with oral acyclovir for herpetic stomatitis had a history of blurred vision OS that was diagnosed as cytomegalovirus retinitis. The patient refused ganciclovir administration. Two additional lesions developed OS in the succeeding four months. All clinical evidence of active retinitis cleared after zidovudine was administered, and the patient has remained free of any clinically active retinal lesions for 28 months while continuing to receive acyclovir and zidovudine. Although ganciclovir and foscarnet are the drugs of choice to treat cytomegalovirus retinitis, this observation may be fortuitous for patients whose other AIDS manifestations suggest using zidovudine rather than ganciclovir or for patients whose cytomegalovirus retinitis appears to be resistant to agents currently used to treat this infection.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Cytomegalovirus Infections; Eye Infections, Viral; Fluorescein Angiography; Follow-Up Studies; Fundus Oculi; HIV Seropositivity; Humans; Male; Retinitis; Visual Acuity; Zidovudine

Topics: Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Foscarnet; Humans; Immunosuppression Therapy; Phosphonoacetic Acid; Retinitis; Retrospective Studies; Tacrolimus; Transplantation Immunology

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

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

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

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Cytomegalovirus; Cytomegalovirus Infections; DNA, Viral; Drug Resistance, Microbial; Female; Ganciclovir; Humans; Immune Tolerance; Immunosuppression Therapy; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Middle Aged; Retinitis

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Cytomegalovirus Infections; Ganciclovir; Humans; Retinitis

Long-term management of cytomegalovirus (CMV) retinitis by intravitreal injection of ganciclovir was evaluated in ten patients with acquired immune deficiency syndrome (AIDS). Patients were unable to tolerate systemic ganciclovir because of severe neutropenia (8 cases), catheter-induced sepsis (1 case), or the need to continue therapy for human immunodeficiency virus (HIV) with zidovudine (ZDV) (1 case). All patients had a favorable response to initial treatment. Cytomegalovirus retinitis progressed in four fellow eyes in which treatment was deferred. Vision improved or remained stable in all but one eye. Patients were followed for a mean of 4 months and received an average of 16.6 intravitreal injections in each eye. Relapse occurred late in the course while on maintenance treatment in five eyes (33%). There was no evidence of toxicity from repeated intravitreal injections. Treatment was very well tolerated. The only severe complication in a total of 249 injections was a single case of Staphylococcus epidermidis endophthalmitis which responded to intravitreal antibiotic treatment. Intravitreal ganciclovir is an effective alternative to systemic ganciclovir in those patients with severe neutropenia and in those patients who desire to remain on systemic ZDV.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Cytomegalovirus Infections; Ganciclovir; Humans; Injections; Long-Term Care; Middle Aged; Opportunistic Infections; Retinitis; Vitreous Body

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Cytomegalovirus Infections; Ganciclovir; Humans; Male; Retinitis; Thrombocytopenia; Vitreous Hemorrhage

Topics: Acyclovir; Adult; Antiviral Agents; Cytomegalovirus Infections; Endophthalmitis; Ganciclovir; Humans; Injections; Male; Retinitis; Staphylococcal Infections; Staphylococcus epidermidis; Vitreous Body

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Antiviral Agents; Colony-Stimulating Factors; Cytomegalovirus Infections; Ganciclovir; Granulocyte-Macrophage Colony-Stimulating Factor; Growth Substances; Humans; Retinitis

A case is reported of a 35-year-old male with established acquired immune deficiency syndrome who developed cytomegalovirus retinitis. When intravenous treatment with ganciclovir had to be withdrawn because of toxicity, one eye was treated successfully by intravitreal injections of the drug. After 15 weeks of intravitreal treatment this eye developed endophthalmitis.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Cytomegalovirus Infections; Ganciclovir; Humans; Injections; Male; Retinitis; Vitreous Body

Nine patients with unilateral cytomegalovirus (CMV) retinitis were treated with intravenous infusions of the new virustatic drug DHPG (Ganciclovir). The induction dose was 10 mg/kg body weight per day (2-5 weeks). In six cases, a maintenance dose was given thereafter of 5 mg/kg body weight per day. After the induction dose, five patients had visual improvement and satisfactory cicatrization. In one patient, PVR (proliferative vitreous reaction) developed with total tractional retinal detachment. More ocular complications were seen while on longterm therapy: relapses during discontinuation because of leukopenia (three times in two patients), breakthrough (= relapse during maintenance therapy) (one case), serous retinal detachment (one case), and optic atrophy (two cases). The complications caused blindness in two further patients. Only one patient has tolerated maintenance therapy for 22 weeks without having any complications. One patient wanted to have therapy suspended and has remained free of relapse for 28 weeks while on cytostatic therapy. The eyes of two deceased patients were examined histopathologically, immunhistochemically, and ultrastructurally and the findings compared with those of an untreated case. Given at an early stage and without discontinuation, DHPG is an effective means of preventing or delaying blindness caused by cytomegalovirus retinitis in AIDS patients. The directives for an optimal dosage are subject to further prospective randomized clinical studies.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Ganciclovir; Humans; Injections; Opportunistic Infections; Retinitis; Vitreous Body

Of 147 patients with AIDS (Walter Reed 3-6), 28 showed signs of retinal infection. Toxoplasmic retinochoroiditis had developed in 5 eyes of 4 patients, whereas cytomegalovirus (CMV) retinitis occurred in 40 eyes of 24 patients. All patients with toxoplasmosis complained of visual symptoms at the first visit, but only 60% of patients with CMV retinitis had ocular symptoms at this time. The important problems involved in making a timely and correct diagnosis (early CMV retinitis vs cotton wool spots vs toxoplasmic retinitis; significance of laboratory data) are presented and discussed. The course of CMV retinitis is sometimes fast and devastating and requires immediate treatment to prevent blindness in patients who are in otherwise still fair general health. Eighteen patients (28 eyes) were treated by intravenous ganciclovir (DHPG) for 1-9 months. Initial therapy (10 mg/kg body wt., 2-4 weeks) led to regression of fundus lesions in all eyes. Under maintenance treatment (5 mg/kg BW body wt., 5 times a week), 14 eyes still demonstrated significant regression or cicatrization of the lesions, 9 eyes showed little progress and 5 eyes moderate recovery. However, 8 of 12 untreated eyes became legally blind before the patient died. None of the 23 treated eyes with useful initial visual acuity (greater than or equal to 0.2) lost visual function. Only in three cases did the drug have to be stopped because of serious side effects (severe leukopenia, pancytopenia, psychosis). Toxoplasmic retinochoroiditis healed in all affected eyes after specific treatment (pyrimethamine, sulfamethoxydiazine, clindamycin, and spiramycin in double or triple combination).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Coccidiostats; Cytomegalovirus Infections; Drug Therapy, Combination; Follow-Up Studies; Ganciclovir; Humans; Male; Middle Aged; Opportunistic Infections; Retinitis; Toxoplasmosis, Ocular

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Ganciclovir; Humans; Infusions, Intravenous; Retinitis

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Ganciclovir; Humans; Retinitis

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

Acute retinal necrosis syndrome in a healthy 32-year-old man was treated successfully with systemic acyclovir and corticosteroids in combination with vitrectomy, 360 degrees encircling band and transscleral cryocoagulation. Herpes simplex virus antibodies were detected in the vitrectomy aspirate supporting the current view that acute retinal necrosis is caused by viruses of the herpes group.

Topics: Acute Disease; Acyclovir; Adult; Humans; Male; Necrosis; Retinitis; Syndrome; Vasculitis; Vitrectomy

Electroretinographic (ERG) investigations were performed in three AIDS patients. The first had cotton wool-like spots in both eyes (AIDS "retinopathy"). The second presented with the same changes in his right eye and an acute cytomegalovirus (CMV) in his left eye. In the third patient signs of healed peripheral retinochoroiditis were found. In CMV retinitis the retinal damage demonstrated by ERG correlated well with the ophthalmoscopic findings. As the ERG improved concurrently with Ganciclovir therapy, retinal function can be monitored by means of ERG controls. In the cases of AIDS "retinopathy" with only a few cotton wool-like spots and with healed peripheral retinochoroiditis, pronounced changes in the ERG were seen regularly; these were most probably caused by ischemia of the inner retinal layers.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Electroretinography; Ganciclovir; Humans; Opportunistic Infections; Retina; Retinitis

We examined three patients with AIDS who had large, sharply demarcated areas of thinned retina consistent with inactive cytomegalovirus retinitis and who were not treated with ganciclovir. These lesions appeared identical to clinically inactive areas of cytomegalovirus retinitis after effective antiviral treatment. All patients were receiving azidothymidine or ribavirin, or both, which have activity against the human immunodeficiency virus and which may improve immune function. All patients also received oral acyclovir at doses ineffective against cytomegalovirus retinitis.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Cytomegalovirus Infections; Fluorescein Angiography; Fundus Oculi; Humans; Male; Retinitis; Ribavirin; Thymidine; Zidovudine

The eyes of an AIDS patient with cytomegalovirus (CMV) retinitis and pneumonitis who died while receiving maintenance therapy with the antiviral agent 9-[2-hydroxy-1-(hydroxymethyl) ethoxymethyl] guanine (Ganciclovir) were obtained for pathological examination. While under treatment the patient had significant improvement but not complete regression of retinitis. Electron microscopic and immunofluorescent techniques revealed cytomegalovirus particles in the retina, sclera, iris, and ciliary body. These findings are consistent with a virostatic type of inhibition of CMV by this agent. They also suggest that CMV involvement in the eye and other organs may be more widespread than is clinically apparent in AIDS patients.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Ciliary Body; Cytomegalovirus; Cytomegalovirus Infections; Eye; Ganciclovir; Humans; Iris; Male; Retina; Retinitis

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Cytomegalovirus Infections; Ganciclovir; Humans; Male; Remission, Spontaneous; Retinitis

Six patients (11 eyes) with virologically confirmed cytomegalovirus (CMV) retinitis involving the posterior pole of the eye were treated with a new drug, ganciclovir. Treatment with intravenous ganciclovir consistently halted progression of retinitis and produced improvement in measures of visual function. However, within three weeks after cessation of therapy renewed CMV activity and worsening of visual function were observed in most cases. Maintenance therapy with ganciclovir extended the period of remission from CMV retinitis.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Cytomegalovirus Infections; Female; Fundus Oculi; Ganciclovir; Humans; Male; Middle Aged; Retinitis; Visual Acuity

The efficacy and toxicity of ganciclovir given by intravenous or intravenous plus intravitreal injection were studied in nine patients with cytomegalovirus (CMV) retinitis; seven with AIDS and two with drug induced immunodeficiency. Five patients had retinitis with macular involvement in six sighted eyes; six patients had only peripheral retinitis in seven eyes. In two patients (two eyes) with macular involvement intravenous plus intravitreal injection of ganciclovir preserved sight; intravenous infusion alone did not in four eyes of three other patients. In seven eyes (six patients) with peripheral retinitis vision was retained regardless of the route of ganciclovir treatment. Following intravenous ganciclovir drug levels in the vitreous fluid were 1.4-2.2 mmol/l, that is, 44 and 65% of the concomitant serum concentration. Clinically and at necropsy three eyes showed no evidence of toxicity from intravitreal injection of ganciclovir. All of five patients with AIDS who received intravenous ganciclovir for more than one week developed leucopenia. CMV retinitis of the macula may be benefited with minimal drug toxicity by intravitreal injection of ganciclovir. Treatment of peripheral CMV retinitis in patients with AIDS may be optional.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Ganciclovir; Humans; Immunosuppression Therapy; Injections, Intravenous; Leukopenia; Retinitis; Visual Acuity; Vitreous Body

The acquired immunodeficiency syndrome (AIDS) affects the ocular structures in several ways. Kaposi's sarcoma has been observed on the bulbar conjunctiva of the globe. Retinal complications, however, are of major concern. Cotton-wool spots are commonly seen in AIDS patients and are usually of no consequence, except that they must be distinguished from the early stages of cytomegalovirus (CMV) retinitis, seen in 20-40% of these patients. CMV causes a necrotic-type retinitis potentially leading to blindness. 9-[2-Hydroxy-1-(hydroxymethyl)ethoxymethyl]guanine (DHPG) has been found effective in the short-term treatment of this disorder. It is planned to use AS101 in the regimen to see if a long-term cure from this disease can be affected. Care must be taken in handling ocular tissue of AIDS patients or the re-use of ophthalmic instruments touching the eye of AIDS patients since the human immunodeficiency virus has been found in these structures.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Cytomegalovirus Infections; Eye Diseases; Ganciclovir; HIV; Humans; Retinitis

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Cytomegalovirus Infections; Ganciclovir; Homosexuality; Humans; Injections; Male; Retinitis; Vitreous Body

Of 760 AIDS patients seen at San Francisco General Hospital in 1986, 5.7 per cent had retinitis and 2.2 per cent had gastrointestinal disease caused by cytomegalovirus. We reviewed the records of 44 patients treated with ganciclovir for culture-confirmed cytomegalovirus retinal (31 patients) or gastrointestinal disease (17 patients) or both (four patients) in 1986. Retinitis stabilized or improved during initial treatment with ganciclovir in 22 of 27 (81.5 per cent) patients. Following a median 10-day induction course, 16 patients with retinitis continued to have serial ophthalmologic assessments: eight patients were maintained on treatment and eight had maintenance treatment deferred. Before treatment, the two groups were comparable in age, Karnofsky scores, hematologic assessment, visual acuity, and history with respect to Pneumocystis carinii pneumonia. Retinitis did not progress for a median 53.8 days in the immediate maintenance group compared to 18.8 days for the deferred maintenance group (p = 0.01). In 17 patients with CMV gastrointestinal disease, nine of 14 (64 per cent) had resolution of pain and eight of 11 (73 per cent) had resolution of diarrhea when treated initially with ganciclovir. In both retinitis and gastrointestinal disease patients, ganciclovir decreased recovery of CMV from urine and blood markedly. Ganciclovir also caused a decrease in mean absolute neutrophil counts to about half of baseline values; decreases in mean platelet count and hemoglobin were also noted but were less than 25 per cent. Neutropenia severe enough to require dose adjustment (less than 800 cells/microliters) occurred in 31 per cent of patients receiving maintenance ganciclovir.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Ganciclovir; Gastrointestinal Diseases; Humans; Neutropenia; Opportunistic Infections; Retinitis

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; B-Lymphocytes; Drug Therapy, Combination; Female; Fluorescein Angiography; Herpes Zoster; Humans; Leukemia, T-Cell; Lymphoma; Middle Aged; Necrosis; Recurrence; Retinitis; Vidarabine

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

Ganciclovir is a nucleoside analog which inhibits the replication of herpesviruses in vitro and which has been effective by intravenous administration for the treatment of severe cytomegalovirus infection in immunocompromised patients. Because most patients with acquired immunodeficiency syndrome and severe cytomegalovirus infection have required lifelong daily suppressive ganciclovir therapy to control disease progression, oral therapy appears to have practical advantages. We studied the pharmacokinetics of orally administered ganciclovir in four patients with acquired immunodeficiency syndrome and cytomegalovirus retinitis. Repeated oral ganciclovir doses (10 to 20 mg/kg every 6 h) were well tolerated. With a 20-mg/kg dose given every 6 h, mean steady-state peak and trough levels were 2.96 and 1.05 microM, respectively, and the area under the concentration-time curve from 0 to 24 h was 47 microM X h. Calculated absorption was 3.0%, based on urinary excretion. Because the levels achieved in serum with oral ganciclovir approximated those required to inhibit cytomegalovirus in vitro, a trial of oral maintenance therapy in immunocompromised patients with severe cytomegalovirus infections seems warranted.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Antiviral Agents; Cytomegalovirus; Cytomegalovirus Infections; Drug Tolerance; Ganciclovir; Humans; Kinetics; Leukocyte Count; Retinitis

Eighteen immunocompromised patients with cytomegalovirus (CMV) retinitis were treated with ganciclovir, an investigational antiviral drug. CMV retinitis in association with acquired immune deficiency syndrome (AIDS) developed in 17 patients; CMV retinitis developed in one patient after cardiac transplantation. Fourteen patients responded to ganciclovir treatment with improvement in CMV retinitis. In 11 patients, the response was classified as complete; in three patients, the response was partial. Continued improvement in the retinitis was often seen while the patient was on maintenance treatment. Maintenance ganciclovir therapy was required; relapse occurred in five of seven patients in whom ganciclovir treatment was interrupted. The major limiting toxic side effect of ganciclovir was neutropenia, which necessitated temporary discontinuation of ganciclovir in five patients but was reversible in all cases. Ganciclovir appears to be an effective therapy for CMV retinitis, but chronic maintenance therapy is required.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Cytomegalovirus Infections; Eye; Ganciclovir; Humans; Recurrence; Retinitis

A total of 66 eyes in 41 patients were treated for cytomegalovirus (CMV) retinitis with a new acyclic nucleoside, ganciclovir (BW B759U). At the completion of the short-term therapy period of 21 days, 87.7% of eyes had stabilized or improved. Seventy-two percent of eyes stabilized or improved during long-term home maintenance therapy. Leukopenia and increased liver function abnormalities were the most common adverse drug reactions seen in this series. Ganciclovir dramatically improved the quality of life in these patients, but clinical evidence suggests that it is a virostatic medication requiring indefinite long-term maintenance therapy.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Alkaline Phosphatase; Cytomegalovirus Infections; Female; Ganciclovir; Humans; Leukocyte Count; Liver; Male; Middle Aged; Retinitis; Time Factors

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Cytomegalovirus Infections; Ganciclovir; Humans; Male; Retinitis

Three patients with acquired immunodeficiency syndrome (AIDS) and disseminated cytomegalovirus (CMV) infection were treated with a new antiviral agent ganciclovir [9(1,3-dihydroxy-2-propoxymethyl) guanine] (DHPG). All initially showed dramatic clinical improvement. In two patients, serial ophthalmoscopic evaluations documented cessation of active retinitis although at autopsy one patient had evidence of active retinitis adjacent to scar. Reappearance of cotton-wool spots in the fundi of the third patient suggested an early relapse of his CMV infection which was halted by retreatment with ganciclovir. Two of the three patients developed breakthrough infection while receiving once-daily maintenance therapy after periods of three to five months. One patient continued to show a response to retreatment with full doses twelve months later but died after 17 months of progressive CMV disease. The dose of the drug needed to maintain remission requires further study.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Cytomegalovirus; Cytomegalovirus Infections; Ganciclovir; Humans; Male; Ophthalmoscopy; Retinitis

We present a case of cytomegalovirus (CMV) retinitis in an AIDS patient who survived for 10 months after the start of his ocular problems. The retinitis responded to dihydroxy propoxy methyl guanine (DHPG) but relapsed four to six weeks after each course of treatment with progressive retinal destruction. One relapse was therefore treated with trisodium phosphoformate hexahydrate (Foscarnet). There are few reports of the use of this drug in the treatment of CMV retinitis with AIDS, but it appeared to be less effective in our patient than DHPG, possibly because of poor penetration of the blood-ocular barrier. A final course of outpatient maintenance therapy with DHPG failed to prevent a preterminal relapse of the retinitis. Fundus photographs demonstrated the resolution and relapse of the retinitis associated with each course of treatment. Maintenance therapy with DHPG would appear to be necessary to prevent relapse, but the logistics of this are difficult, and the effective dosage of DHPG is as yet uncertain.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Foscarnet; Fundus Oculi; Ganciclovir; Humans; Male; Middle Aged; Phosphonoacetic Acid; Retina; Retinitis; Visual Acuity

A patient with acquired immune deficiency syndrome with bilateral cytomegalovirus retinitis was treated with intravitreal 200-micrograms/0.1-ml doses of ganciclovir (9-[2-hydroxy-1-(hydroxymethyl) ethoxymethyl]guanine). The ganciclovir serum and intravitreal concentrations were measured with an enzyme-linked immunosorbent assay and pharmacokinetic factors were determined. There was no evidence of systemic absorption of ganciclovir from the eye. The elimination half-life of ganciclovir from the vitreous was estimated to be 13.3 hours. The intravitreal concentration remained above the ID50 of cytomegalovirus for approximately 62 hours after a single injection. Clinically, the patient retained useful vision in his right eye for three months. A total of 28 intravitreal injections were given on an outpatient basis under topical anesthesia and were well tolerated. There was no evidence of retinal toxicity from the drug.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Cytomegalovirus Infections; Ganciclovir; Humans; Injections; Male; Retinitis; Visual Acuity; Vitreous Body

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Cytomegalovirus Infections; Ganciclovir; Humans; Male; Middle Aged; Retinitis

Asymptomatic retinal lesions were found on annual ophthalmic examination in a 38-year-old homosexual man with the acquired immune deficiency syndrome (AIDS). The lesions were compatible with cytomegalovirus retinitis and progressed. Treatment with 9-(1,3-dihydroxy-2-propoxymethyl)guanine (DHPG) resulted in regression of the lesions and improvement in his overall clinical condition. The retinal lesions in AIDS are reviewed.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Cytomegalovirus Infections; Ganciclovir; Humans; Male; Retina; 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

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Cytomegalovirus Infections; Ganciclovir; Humans; Male; Middle Aged; Recurrence; Retinitis

Topics: Acyclovir; Adult; Antiviral Agents; Cytomegalovirus Infections; Ganciclovir; Humans; Injections; Male; Retinitis; Thymidine; Vitreous Body; Zidovudine

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Colitis; Cytomegalovirus Infections; Ganciclovir; Humans; Male; Retinitis

A 15-month prospective study of 109 patients with the acquired immune deficiency syndrome (AIDS) or AIDS-related complex (ARC) was conducted. Cytomegalovirus (CMV) retinitis developed in 18 of these patients; they were treated with ganciclovir. Five other patients with CMV retinitis who were not part of the prospective study were also treated with ganciclovir. CMV retinitis frequently involved the peripheral retina. All 23 patients treated with ganciclovir showed clinical regression of retinitis, although breakthrough recurrence of CMV retinitis occurred in seven patients (30.4%) while on maintenance therapy with ganciclovir. During treatment, neutropenia (less than 1000 leukocytes/mm3) developed in three patients (13%). Ganciclovir is an effective means of therapy for CMV retinitis, but it must be given chronically to prevent reactivation. Breakthrough recurrences while on maintenance therapy are not uncommon, but can be successfully treated with more aggressive treatment with ganciclovir. In addition, the prognosis for survival of AIDS patients being treated with ganciclovir is improved when compared with that of untreated patients.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Cytomegalovirus Infections; Ganciclovir; Humans; Male; Middle Aged; Neutropenia; Prospective Studies; Recurrence; Retinitis

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Cytomegalovirus Infections; Ganciclovir; Humans; Injections; Retinitis; Vitreous Body

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Ganciclovir; Humans; Leukoplakia, Oral; Male; Middle Aged; Retinitis; Tongue Neoplasms

Two patients (3 eyes) had a history and clinical findings typical of acute retinal necrosis syndrome. Ten-day treatment with intravenous acyclovir and topical cycloplegia resulted in rapid resolution of the vitreoretinal findings and a swift return to near normal vision. All three eyes have maintained normal vision, and there have been no retinal detachments over a year after treatment.

Topics: Acyclovir; Adult; Female; Humans; Male; Necrosis; Retinitis

The acute retinal necrosis (ARN) syndrome is a morphologically defined necrotizing retinitis, occurring in apparently otherwise healthy patients. It has been shown that the varicella zoster virus is at least one cause of the ARN syndrome; treatment with acyclovir has proven to be effective for the infectious component of ARN. We report three immunocompromised patients who developed cutaneous herpes zoster and a necrotizing retinitis that was morphologically similar to the ARN syndrome. All three patients responded promptly to treatment with acyclovir, an agent highly effective against varicella zoster and herpes simplex viruses, but ineffective in the treatment of cytomegalovirus. While cytomegalovirus retinitis is more common in immunocompromised patients, these patients may occasionally develop an ARN-like retinitis, presumably as a result of the varicella zoster virus, which responds to treatment with acyclovir.

Topics: Acyclovir; Adult; Herpes Zoster; Humans; Immune Tolerance; Male; Middle Aged; Retinitis

Eight immunosuppressed homosexual men with cytomegalovirus viremia--seven with serious bilateral retinitis, one with colitis in addition to retinitis, and one with pneumonitis only--were treated with a new acyclovir derivative, 9-(1,3-dihydroxy-2-propoxymethyl) guanine, which has excellent in-vitro activity against cytomegalovirus. All patients had virologic and clinical improvement, but substantial leukopenia developed in three patients. Both clinical relapses and viral relapses occurred frequently, usually within 30 days after cessation of treatment. 9-(1,3-Dihydroxy-2-propoxymethyl) guanine represents the first clinically and virologically effective agent for the treatment of cytomegalovirus disease, but more effective and less toxic therapeutic regimens for both acute and chronic use must be developed.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Agranulocytosis; Antiviral Agents; Colitis; Cytomegalovirus Infections; Ganciclovir; Hodgkin Disease; Homosexuality; Humans; Male; Pneumonia, Viral; Retinitis

Eight patients with cytomegalovirus retinitis in one or both eyes were treated with 9-(1,3 dihydroxy 2-propoxymethyl) guanine. Of the 14 eyes with retinitis, eight demonstrated more than 90% resolution, four had partial improvement, one failed to respond, and one could not be evaluated. Two of the eight patients had chemotherapy-induced immunosuppression and had ocular remissions for at least several months. The remaining six patients had AIDS or probable AIDS and relapsed in five weeks or less after discontinuation of therapy. Dihydroxy propoxymethyl guanine appears to be effective biologically in treating human cytomegalovirus retinitis without the development of unacceptable side effects but a single course of therapy is not capable of eradicating the virus.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Cytomegalovirus Infections; Drug Evaluation; Female; Ganciclovir; Humans; Male; Middle Aged; Recurrence; Retinitis; Visual Acuity

The drug 9-(1,3-dihydroxy-2-propoxymethyl)-guanine (DHPG) was used to treat serious cytomegalovirus infections in 26 patients with underlying immunodeficiency (including 22 with the acquired immunodeficiency syndrome). In 17 of 22 patients in whom cytomegalovirus was virologically confirmed, clinical status improved or stabilized, although in 4 of them the status of some affected organs deteriorated or did not improve. Fourteen of 18 patients with adequate viral-culture data had clearing of cytomegalovirus from all cultured sites. Patients with cytomegalovirus pneumonia often responded poorly; four of seven died before completing 14 days of DHPG therapy. The condition of 11 of 13 patients with cytomegalovirus retinitis and 5 of 8 with gastrointestinal disease stabilized or improved. However, clinical and virologic relapses occurred in 11 of 14 patients (79 percent) when DHPG was discontinued. Neutropenia was the most frequent adverse reaction. We conclude that DHPG offers promise for the therapy of severe cytomegalovirus infections in some immunodeficient patients, but further study will be necessary to establish its efficacy and safety.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Child, Preschool; Cytomegalovirus; Cytomegalovirus Infections; Drug Evaluation; Female; Ganciclovir; Gastrointestinal Diseases; Humans; Immune Tolerance; Immunologic Deficiency Syndromes; Infant; Male; Middle Aged; Pneumonia, Viral; Recurrence; Retinitis

Six patients (all male, five homosexual and one bisexual, 23 to 48 years old) with the acquired immune deficiency syndrome (AIDS) who had cytomegalovirus retinitis were treated with a new antiviral drug as a part of a prospective open-labeled trial for serious cytomegalovirus infections. The drug, 9-[2-hydroxy-1-(hydroxymethyl)ethoxymethyl] guanine (referred to as dihydroxy propoxymethyl guanine), a new acyclic nucleoside antiviral agent similar in structure to acyclovir, produced positive results. These patients treated with dihydroxy propoxymethyl guanine (2.5 mg/kg of body weight every eight hours) showed regression and often disappearance of the lesions of cytomegalovirus retinitis during and for several weeks after therapy, usually with concomitant resolution of viral shedding. The cytomegalovirus retinitis recurred in four patients (the other two were lost to follow-up), but retreatment usually led to remission. Adverse drug toxicity (reversible granulocytopenia) occurred in two patients.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Cytomegalovirus Infections; Ganciclovir; Humans; Male; Middle Aged; Retinitis

Topics: Acyclovir; Cytomegalovirus Infections; Ganciclovir; Humans; Male; Retinitis

Clearance studies in rabbits following intravitreal injection of 400 micrograms of 9-([2-Hydroxy-1-(hydroxymethyl)ethoxy]methyl) guanine demonstrated levels of the antiviral at 60 hours above the in vitro ID50 for several strains of human cytomegalovirus. Intravitreal administration of this new antiviral may have therapeutic application in the treatment of acute retinal necrosis and cytomegalovirus retinitis complicating acquired immune deficiency syndrome (AIDS).

Topics: Acyclovir; Animals; Aqueous Humor; Conjunctiva; Cytomegalovirus Infections; Eye; Ganciclovir; Injections; Osmolar Concentration; Rabbits; Retinitis; Vitreous Body

The pharmacokinetics of the antiviral drug 9-[2-hydroxy-1-(hydroxymethyl) ethoxymethyl]guanine (DHPG) were examined in six patients receiving 2.5 or 5.0 mg/kg every 8 or 12 hours for human cytomegalovirus (HCMV) pneumonitis or retinitis. Biexponential decay with a mean distribution t1/2 of 0.23 hours and terminal t1/2 of 2.53 hours was observed. Total clearance correlated well with and exceeded creatinine clearance by a factor of 2.4. Mean volume of the central compartment was 15.26 L/1.73 m2 and the volume of distribution at steady state was 32.8 L/1.73 m2. Peak (model predicted) and trough plasma concentrations were 4.75 to 6.20 micrograms/ml and less than 0.25 to 0.63 microgram/ml, respectively, in patients receiving 2.5 mg/kg. Peak concentrations are well above those needed to inhibit HCMV at the 50% level (ID50) and troughs are near this ID50. Cerebrospinal fluid concentrations of DHPG indicate a penetration of 24% to 67%. No accumulation of DHPG was apparent in these patients. However, dosage reduction is necessary in renal insufficiency. Neutropenia occurred in one patient. The plasma concentration profile of DHPG suggests potential beneficial activity against HCMV.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Cytomegalovirus Infections; Female; Ganciclovir; Humans; Kinetics; Male; Middle Aged; Neutropenia; Pneumonia; Retinitis; Time Factors

Topics: Acyclovir; Adolescent; Antiviral Agents; Cytomegalovirus Infections; Ganciclovir; Humans; Male; Retinitis

Recent reports have suggested a role for BW-B759U in the treatment of cytomegalovirus retinitis. The present study presents the ophthalmoscopic features in three treated patients, and examines the microscopic findings in the eyes of the first patient ever treated with BW-B759U for cytomegalovirus retinitis. Ophthalmoscopic findings of improvement on drug therapy included remission of perivascular infiltration, stabilization of the extent of the retinal area involved, and development of a pigmented chorioretinal scar in the involved area. Relapses occurred with cessation of therapy, and repeated courses of therapy were required. One patient developed a rhegmatogenous detachment with retinal breaks in an atrophic area of treated retinitis. Electron microscopic examination of the eyes of one patient disclosed the persistence of cytomegalovirus inclusions in retinal cells despite previous drug therapy. These findings suggest a virostatic action for BW-B759U.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Cytomegalovirus Infections; Fundus Oculi; Ganciclovir; Humans; Male; Ophthalmoscopy; Retinitis

The ocular findings in 38 patients infected by the Human T Cell Lymphotropic Virus Type III (HTLV III) are reviewed. Twenty patients were suffering from the Acquired Immunodeficiency Syndrome (AIDS) and 18 from the HTLV III related disease Persistent Generalised Lymphadenopathy (PGL). Cotton wool spots were found in the retinae of 8 patients at some stage of their disease and the prognostic significance of these is discussed. Cytomegalovirus (CMV) Retinitis was an ocular complication in eight of the patients with AIDS. The therapeutic effects of a new anti-viral drug, di-hydroxy propoxymethyl guanine (DHPG), are discussed.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; AIDS-Related Complex; Antiviral Agents; Cytomegalovirus Infections; Eye Diseases; Fundus Oculi; Ganciclovir; Humans; Retinal Hemorrhage; Retinitis

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

The number of AIDS patients is still increasing. In 30-50% of these patients ocular lesions occur, which are of diagnostic and prognostic significance. If the life-span of AIDS patients lengthens in the future, adequate treatment of the ocular conditions will become increasingly important. The two most important ocular manifestations AIDS are CMV-retinitis and Kaposi's sarcoma of the conjunctiva. DHPG, a new virustatic for human cytomegalovirus, appears promising as treatment for the severe CMV-retinitis, which leads rapidly to blindness. Two case histories illustrate the preliminary results obtained with DHPG treatment. Kaposi's sarcoma of the conjunctiva is relatively benign is AIDS and can be treated successfully by surgical excision, radiotherapy, cryotherapy or local injections of cytostatics.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Chemical Phenomena; Chemistry; Conjunctival Neoplasms; Cytomegalovirus Infections; Ganciclovir; Humans; Male; Middle Aged; Retinitis; Sarcoma, Kaposi

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

Cytomegalovirus infections can cause significant morbidity and mortality in immunosuppressed patients, and present antiviral agents have had little efficacy against these infections. We describe the use of an acyclic nucleoside 9-[2-hydroxy-1-(hydroxymethyl) ethoxy methyl]guanine (BW B759U), in the treatment of two patients with cytomegalovirus retinitis. The efficacy of this agent was evident, with healing of retinal lesions and resolution of viremia and viral shedding. BW B759U appears to be similar pharmacokinetically to intravenous acyclovir in terms of half-life, peak serum levels, and renal excretion.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Cytomegalovirus Infections; Fundus Oculi; Ganciclovir; Half-Life; Humans; Male; Neutrophils; Retinitis

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Cytomegalovirus Infections; Ganciclovir; Humans; Male; Respiratory Tract Infections; Retinitis

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Humans; Infusions, Parenteral; Male; Retinitis; Virus Diseases

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

49 cases of acquired cytomegalovirus retinitis were reviewed including three new cases in renal allograft recipients and one in a patient with Hodgkin's Disease. Diagnosis in over 90% of cases was based on the distinctive funduscopic appearance of cytomegalovirus (CMV) retinitis. When performed, urine, subretinal fluid, and blood buffy coat cultures were positive for CMV in 97, 67 and 39% of cases, respectively. More than two-thirds of these patients were organ transplant recipients who received chronic immunosuppressive therapy. Attempted therapy of CMV retinitis with a variety of regimens has not been proven to be effective. At present, no specific treatment is recommended unless it is given under a controlled therapeutic trial.

Topics: Acyclovir; Adult; Aged; Cytomegalovirus Infections; Diagnosis, Differential; Humans; Kidney Transplantation; Male; Middle Aged; Retinitis; Vidarabine