valacyclovir and Eye-Infections--Viral

To define a clinically tailored therapeutic strategy for the treatment of viral anterior uveitis (VAU).. A PubMed search spanning the past 5 years was conducted using the MesH-terms "viral anterior uveitis" and "therapy.". The herpes simplex virus (HSV), the varicella zoster virus (VZV), and the cytomegalovirus (CMV) are the predominant pathogens in VAU. Other viruses, including rubella, chikungunya, and zika, have been linked with distinct forms of the disease. Depending on the causative agent and the host immunocompetence, the mainstay treatment for suspected VAU is a combination of topical or systemic antivirals and topical corticosteroids, supplemented with cycloplegics and intraocular-pressure-lowering medication.. Oral acyclovir, valacyclovir, and famciclovir are the mainstay of treatment for HSV- and VZV-induced infections. Brivudin serves as an alternative in insufficiently responsive cases. CMV-induced infections respond well to valganciclovir. A 3- to 12-month course of prophylactic treatment against recurrences is worth considering.

Topics: Acyclovir; Antiviral Agents; Bromodeoxyuridine; Chikungunya Fever; Cytomegalovirus Infections; Eye Infections, Viral; Famciclovir; Herpes Simplex; Herpes Zoster Ophthalmicus; Humans; Rubella; Uveitis, Anterior; Valacyclovir; Zika Virus Infection

To evaluate the available evidence in peer-reviewed publications about the diagnosis and treatment of acute retinal necrosis (ARN).. Literature searches of the PubMed and Cochrane Library databases were last conducted on July 27, 2016. The searches identified 216 unique citations, and 49 articles of possible clinical relevance were reviewed in full text. Of these 49 articles, 27 were deemed sufficiently relevant or of interest, and they were rated according to strength of evidence. An additional 6 articles were identified from the reference lists of these articles and included. All 33 studies were retrospective.. Polymerase chain reaction (PCR) testing of aqueous or vitreous humor was positive for herpes simplex virus (HSV) or varicella zoster virus (VZV) in 79% to 100% of cases of suspected ARN. Aqueous and vitreous specimens are both sensitive and specific. There is level II and III evidence supporting the use of intravenous and oral antiviral therapy for the treatment of ARN. Data suggest that equivalent plasma drug levels of acyclovir can be achieved after administration of oral valacyclovir or intravenous acyclovir. There is level II and III evidence suggesting that the combination of intravitreal foscarnet and systemic antiviral therapy may have greater therapeutic efficacy than systemic therapy alone. The effectiveness of prophylactic laser or early pars plana vitrectomy (PPV) in preventing retinal detachment (RD) remains unclear.. Polymerase chain reaction testing of ocular fluid is useful in supporting a clinical diagnosis of ARN, but treatment should not be delayed while awaiting PCR results. Initial oral or intravenous antiviral therapy is effective in treating ARN. The adjunctive use of intravitreal foscarnet may be more effective than systemic therapy alone. The role of prophylactic laser retinopexy or early PPV is unknown at this time.

Topics: Academies and Institutes; Acyclovir; Antiviral Agents; Aqueous Humor; Biomedical Technology; DNA, Viral; Eye Infections, Viral; Foscarnet; Herpes Simplex; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Ophthalmology; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Simplexvirus; United States; Valacyclovir; Valine; Vitrectomy; Vitreous Body

Acute retinal necrosis (ARN), also known as Kirisawa-type uveitis, is an uncommon condition caused by infection of the retina by one of the herpes family of viruses, most typically varicella zoster virus or herpes simplex virus and less commonly cytomegalovirus. Clinical diagnosis can be challenging and is often aided by PCR-based analysis of ocular fluids. Treatment typically involves extended use of one or more antiviral agents. Long term retinal detachment risk is high. We review the literature on ARN and present an approach to the diagnosis and management of this serious condition.

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Cytomegalovirus Retinitis; Eye Infections, Viral; Famciclovir; Fluorescein Angiography; Ganciclovir; Herpes Simplex; Humans; Laser Coagulation; Retinal Necrosis Syndrome, Acute; Valacyclovir; Valganciclovir; Valine

Topics: Acyclovir; Adrenal Cortex Hormones; Antiviral Agents; Drug Therapy, Combination; Eye Infections, Viral; Herpes Simplex; Herpes Zoster; Humans; Valacyclovir; Valine; Vitrectomy

Topics: Antiviral Agents; Eye Infections, Viral; Fluorescein Angiography; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Middle Aged; Multimodal Imaging; Photography; Retinal Necrosis Syndrome, Acute; Slit Lamp Microscopy; Valacyclovir; Visual Acuity

To report a case of herpes zoster ophthalmicus (HZO) reactivation after recombinant zoster vaccination.. A 78-year-old woman, with a history of HZO 20 years ago, was referred for progressive corneal thinning in her left eye that started 1 week after her second dose of recombinant zoster vaccination.. At presentation, visual acuity was counting fingers. Corneal sensation was markedly decreased. Slit lamp examination revealed a temporal paracentral epithelial defect 1.5 × 2.0 mm in size with 40% thinning and surrounding stromal inflammation suggestive of stromal keratitis with ulceration. The patient was started on oral valacyclovir, topical erythromycin ointment, and hourly topical lubrication. A bandage contact lens was placed and was replaced 1 week later with self-retained cryopreserved amniotic membrane ring. The ring was removed in the following week when the thinned area was epithelialized with no further evidence of stromal lysis.. HZO reactivation after recombinant zoster vaccination is uncommon but possible. Ophthalmologists should remain aware of potential risks of zoster vaccination and take special precautions in patients with HZO history.

Topics: Aged; Anti-Bacterial Agents; Antiviral Agents; Drug Therapy, Combination; Erythromycin; Eye Infections, Viral; Female; Herpes Zoster Ophthalmicus; Herpes Zoster Vaccine; Herpesvirus 3, Human; Humans; Immunization, Secondary; Latent Infection; Moxifloxacin; Vaccination; Valacyclovir; Virus Activation; Visual Acuity

To report clinical features of acute retinal necrosis (ARN) using optical coherence tomography angiography.. A 59-year-old female patient presented with blurred vision in the left eye for 1 day. The patient presented posterior uveitis with multiple peripheral areas of retinal pallor with presumed acute retinal necrosis. Herpes simplex virus Type 1 infection was confirmed after serologic tests, and the polymerase chain reaction analysis of the aqueous humor tested positive.. The left eye examination revealed anterior chamber reaction, mild vitritis, optic disk swelling, and yellowish white retinal lesions with discrete borders along the superotemporal arcade and temporal periphery. Baseline optical coherence tomography angiography revealed decreased vascular density of superficial and deep plexuses of superotemporal macular region. One month after oral valacyclovir 2,000 mg twice daily, visual acuity and retinal lesions improved, and optical coherence tomography angiography images showed improvement of vascular density.. Occlusive arterial vasculopathy is one of the main clinical characteristics of acute retinal necrosis. We herein describe for the first time the features of retinal vasculature in acute retinal necrosis revealed by optical coherence tomography angiography, showing decreased vascular density of superficial and deep plexuses.

Topics: Antiviral Agents; Aqueous Humor; Eye Infections, Viral; Female; Fluorescein Angiography; Herpes Simplex; Herpesvirus 1, Human; Humans; Middle Aged; Retinal Necrosis Syndrome, Acute; Retinal Vessels; Slit Lamp Microscopy; Tomography, Optical Coherence; Valacyclovir; Visual Acuity

Acute Retinal Necrosis (ARN) is a potentially devastating form of Uveitis. Antivirals are the mainstay treatment for this syndrome. In this letter, we question the current oral Valacyclovir dosage, based on the experience we had with a recent unresponsive ARN case.

Topics: Administration, Oral; Adult; Antiviral Agents; Eye Infections, Viral; Humans; Male; Retinal Necrosis Syndrome, Acute; Valacyclovir; Visual Acuity

To describe and to compare the clinical manifestation and laboratory test results of herpetic anterior uveitis (HAU) caused by Herpes simplex virus (HSV) and varicella-zoster virus (VZV).. A retrospective, observational study on patients diagnosed with HAU. Etiology, clinical features, ocular complications, and recurrences of the infection were evaluated as main clinical parameters. The aqueous Interleukin-8 (IL-8) level was also measured to assess the intraocular inflammation.. Thirty-two eyes (32 patients) were involved. Among all involved cases, 24 had VZV-AU and 8 had HSV-AU. Common clinical features of HAU included the presence of KPs (90.6%), distorted pupil (83.3%), Iris atrophy (71.9%) and corneal edema (50%). The intraocular fluid analysis showed higher viral load and IL-8 level in VZV-AU.. Compared with HSV-AU, the intraocular inflammation was more severe in VZV-AU. The intraocular fluid analysis was valuable for the etiological diagnosis and the evaluation of disease severity.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Aqueous Humor; Asian People; China; Drug Therapy, Combination; Eye Infections, Viral; Female; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpesviridae Infections; Herpesvirus 3, Human; Humans; Interleukin-8; Male; Middle Aged; Referral and Consultation; Retrospective Studies; Simplexvirus; Uveitis, Anterior; Valacyclovir; Viral Load; Visual Acuity; Young Adult

To report 2 cases of herpes simplex virus (HSV) stromal keratitis with epithelial ulceration that were managed using optical coherence tomography-generated pachymetric and corneal epithelial thickness maps.. Two patients with a history of HSV keratitis with nonhealing epithelial defects were referred to the Athens Vision Eye Institute. Anterior segment optical coherence tomography-generated pachymetric and corneal epithelial thickness maps showed subclinical stromal edema and irregular epithelium, thus indicating diagnoses of HSV stromal keratitis with epithelial ulceration. The patients were administered topical preservative-free dexamethasone and oral antiviral therapy. Steroid tapering was guided by pachymetric and corneal epithelial thickness maps at each follow-up visit.. Both patients experienced initial healing of the epithelium and resolution of stromal inflammation. One patient had a recurrence of HSV stromal keratitis with epithelial defect 3 months after initial improvement, with pachymetric and corneal epithelial thickness maps indicating subclinical stromal edema. He was reintroduced to topical steroid therapy, and the stromal edema and epithelial defect subsequently resolved. Both patients have had no recurrences in the past year.. Pachymetric and corneal epithelial thickness maps provide an objective assessment of stromal inflammation and the following 2 clinical advantages in the management of HSV stromal keratitis with epithelial ulceration: (1) they help differentiate it from HSV epithelial keratitis with geographic ulceration and neurotrophic keratopathy and (2) offer objective measurements to guide management with topical corticosteroids until resolution of stromal edema. Thus, treatment can be initiated in a timely manner, and the blinding complications of HSV stromal keratitis can be avoided.

Topics: Administration, Ophthalmic; Administration, Oral; Antiviral Agents; Corneal Pachymetry; Corneal Stroma; Corneal Ulcer; Dexamethasone; Drug Combinations; Epithelium, Corneal; Eye Infections, Viral; Female; Glucocorticoids; Humans; Keratitis, Herpetic; Male; Middle Aged; Tomography, Optical Coherence; Valacyclovir

Varicella-zoster virus is a common cause of morbidity and vision loss in patients worldwide. It can affect any structure of the eye, from keratitis to acute retinal necrosis. Rapid diagnosis and treatment significantly improve clinical outcomes and quality of life.. The purpose of this study was to demonstrate a case where urgent referral to the emergency department was required to treat a patient with disseminated herpes zoster infection.. This is a rare case of varicella-zoster virus encephalitis in a 70-year-old immunocompetent white man who initially presented to the eye clinic for vertical diplopia and floaters. He also had prior thoracic dermatomal rash, followed by new-onset headaches and cerebellar ataxia. Examination revealed a partial oculomotor nerve palsy in the right eye with bilateral optic disc edema and areas of retinitis consistent with acute retinal necrosis in both eyes. Polymerase chain reaction analysis of his aqueous humor and cerebrospinal fluid confirmed an active zoster infection. He received combination systemic and intravitreal antiviral medication until his retinitis resolved but required adjustments for recalcitrant disease and drug-induced nephrotoxicity. While on maintenance dosing of oral valacyclovir, he experienced reactivation in the form of bilateral vasculitis, which was successfully managed once restarting therapeutic oral dosing.. This case describes a successful clinical course of acute retinal necrosis with strategies for its treatment in the setting of varicella-zoster encephalitis. Antiviral medication should be given as soon as possible, as prompt treatment has been shown to improve patient outcomes, although prognosis is typically poor in these cases. Multiple specialists are often needed to address different clinical challenges, including central nervous system involvement, viral strain resistance, disease reactivation, and drug toxicity.

Topics: Aged; Antiviral Agents; Aqueous Humor; Cerebrospinal Fluid; Drug Therapy, Combination; Encephalitis, Varicella Zoster; Eye Infections, Viral; Foscarnet; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Infusions, Intravenous; Intravitreal Injections; Male; Oculomotor Nerve Diseases; Polymerase Chain Reaction; Prednisolone; Quality of Life; Retinal Necrosis Syndrome, Acute; Valacyclovir; Visual Acuity

A 60-year-old man with a history of severe herpes simplex virus type 1 (HSV-1) encephalitis 2 years prior presented with acute onset of visual loss in the left eye. Dilated funduscopic examination showed retinitis and occlusive vasculitis with retinal necrosis. PCR of the vitreous fluid was positive for HSV-1, and he was diagnosed with acute retinal necrosis (ARN) due to HSV-1. The patient was treated with intravenous acyclovir and intravitreous foscarnet for 2 weeks, followed by high dose oral valacyclovir for 2 weeks. He was subsequently placed on planned life-long suppressive valacyclovir. His case demonstrates that acute visual loss concomitant with or subsequent to HSV-1 encephalitis warrants suspicion of ARN. Prompt therapy with effective antiviral medication is necessary to reduce the risk of sight-threatening complications. Chronic suppression with oral antiviral therapy after ARN is recommended to prevent involvement of the contralateral eye, though there is no consensus on the duration and dosage of antivirals.

Topics: Acute Disease; Acyclovir; Antiviral Agents; Diagnosis, Differential; Encephalitis, Herpes Simplex; Eye Infections, Viral; Foscarnet; Herpesvirus 1, Human; Humans; Intravitreal Injections; Male; Middle Aged; Ophthalmoscopes; Rare Diseases; Retinal Necrosis Syndrome, Acute; Treatment Outcome; Valacyclovir

Topics: Antiviral Agents; Drug Prescriptions; Eye Infections, Viral; Humans; Incidence; Keratitis, Herpetic; New Zealand; Risk Factors; Valacyclovir

To evaluate the performance of the xTAG liquid chip technology (xTAG-LCT) for etiological diagnosis of acute retinal necrosis (ARN).. Fifteen vitreous and 3 aqueous samples from 18 ARN patients were analyzed by xTAG-LCT and multiplex PCR (mPCR)/quantitative PCR (qPCR).. xTAG-LCT revealed positive results in 17 of the 18 samples: 10 for Varicella Zoster Virus (VZV) alone; 5 for VZV and Epstein-Barr virus (EBV); 1 for herpes simplex viruses type 1 (HSV-1) and EBV; 1 for VZV, HSV-1 and EBV. While mPCR revealed the same results as xTAG-LCT for VZV and HSV-1 in all samples, only 2 of the 7 samples positive for EBV on xTAG-LCT were confirmed by qPCR. None of the 28 control vitreous samples from 8 non-ARN patients and 10 pair of cadaveric eyes was positive for any of the tested viruses.. xTAG-LCT could be a useful alternative for etiological diagnosis of ARN.

Topics: Acyclovir; Adult; Antiviral Agents; Aqueous Humor; DNA, Viral; Eye Infections, Viral; Female; Ganciclovir; Herpesviridae; Herpesviridae Infections; Humans; Male; Middle Aged; Multiplex Polymerase Chain Reaction; Real-Time Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Valacyclovir; Vitreous Body; Young Adult

To compare the visual outcomes of patients with acute retinal necrosis (ARN) treated initially with intravenous acyclovir vs oral valacyclovir therapy.. Retrospective, comparative, interventional case series.. Sixty-two patients (68 eyes) with ARN, treated at Moorfields Eye Hospital (United Kingdom) between 1992 and 2016, were identified through the hospital's electronic database. Exclusion criteria included insufficient patient records or follow-up (<150 days). Fifty-six patients had unilateral ARN, while 6 had bilateral ARN. Patients who received intravenous acyclovir on diagnosis (n = 33) were compared with patients treated with oral valacyclovir (n = 29) across outcomes including best-corrected visual acuity, retinal detachment, severe vision loss, and other complications. The impact of adjunctive intravitreal antiviral and prophylactic barrier laser treatment was also assessed.. Change in best-corrected visual acuity was not significantly different for eyes treated initially with intravenous therapy vs oral therapy over 5 years of follow-up data (P = .16). There was no difference in the rates of severe vision loss between the 2 groups (46% and 59%, respectively, P = .18), or of those eyes retaining good vision (28% vs 31%, respectively, P = .80). Retinal detachment occurred in 63% of cases and did not differ across treatment groups (62% vs 66%, respectively, P = .67). Barrier laser and intravitreal therapy had no effect on retinal detachment rate in either group.. Oral valacyclovir is clinically equivalent to intravenous therapy in the management of ARN. Oral valacyclovir as an outpatient therapy-with or without intravitreal foscarnet-can therefore be considered as an acceptable alternative to inpatient therapy required for intravenous treatment.

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Eye Infections, Viral; Female; Herpes Simplex; Herpesvirus 3, Human; Humans; Infusions, Intravenous; Male; Middle Aged; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Retrospective Studies; RNA, Viral; Simplexvirus; Valacyclovir; Varicella Zoster Virus Infection; Visual Acuity

Topics: Antiviral Agents; Eye Infections, Viral; Fluorescein Angiography; Foscarnet; Herpes Simplex; Herpesvirus 1, Human; Humans; Intravitreal Injections; Male; Middle Aged; Polymerase Chain Reaction; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Valacyclovir; Vision Disorders

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

To study corneal reinnervation and sensation recovery in Herpes zoster ophthalmicus (HZO).. Two patients with HZO were studied over time with serial corneal esthesiometry and laser in vivo confocal microscopy (IVCM). A Boston keratoprosthesis type 1 was implanted, and the explanted corneal tissues were examined by immunofluorescence histochemistry for βIII-tubulin to stain for corneal nerves.. The initial central corneal IVCM performed in each patient showed a complete lack of the subbasal nerve plexus, which was in accordance with severe loss of sensation (0 of 6 cm) measured by esthesiometry. When IVCM was repeated 2 years later before undergoing surgery, case 1 showed a persistent lack of central subbasal nerves and sensation (0 of 6). In contrast, case 2 showed regeneration of the central subbasal nerves (4786 μm/mm) with partial recovery of corneal sensation (2.5 of 6 cm). Immunostaining of the explanted corneal button in case 1 showed no corneal nerves, whereas case 2 showed central and peripheral corneal nerves. Eight months after surgery, IVCM was again repeated in the donor tissue around the Boston keratoprosthesis in both patients to study innervation of the corneal transplant. Case 1 showed no nerves, whereas case 2 showed new nerves growing from the periphery into the corneal graft.. We demonstrate that regaining corneal innervation and corneal function are possible in patients with HZO as shown by corneal sensation, IVCM, and ex vivo immunostaining, indicating zoster neural damage is not always permanent and it may recover over an extended period of time.

Topics: Acyclovir; Aged; Aged, 80 and over; Antiviral Agents; Artificial Organs; Cornea; Eye Infections, Viral; Female; Fluorescent Antibody Technique, Indirect; Herpes Zoster Ophthalmicus; Humans; Microscopy, Confocal; Nerve Regeneration; Prosthesis Implantation; Recovery of Function; Sensation; Trigeminal Nerve; Tubulin; Valacyclovir; Valine

Topics: Acyclovir; Administration, Oral; Adult; Antiviral Agents; Blepharitis; Eye Infections, Viral; Eyelid Diseases; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Skin Ulcer; Valacyclovir; Valine

Aciclovir (ACV), valaciclovir (VACV) and famciclovir (FCV) are used for systemic infections caused by herpes virus. In Japan, only topical ACV is permitted for use against herpetic keratitis. We investigated the effectiveness of topical ACV, oral VACV and oral FCV on mouse epithelial herpetic keratitis.. C57/BL76 mice were inoculated with HSV-1 McKrae strain in the cornea. Once infection was confirmed 4 days after inoculation, topical ACV, oral VACV and FCV were started and administered for 5 days. Control groups were given either topical or oral saline. On days 2, 4, 6 and 10 after medication started, tears, eyeballs, and trigeminal ganglia were examined using viral culture and real-time PCR.. Viral culture of tears detected no HSV in the topical ACV group on day 4 after administration start; with similar results for the oral VACV group on day 4; and the oral FCV group on day 6. Real-time PCR of the eyeballs showed significant decrease of HSV DNA copy number in the topical ACV group on days 4 and 6 compared to the topical saline group. Real-time PCR of the trigeminal ganglia showed significant decrease of HSV DNA copy number in the oral VACV group on days 4 and 6, and in the oral FCV group on day 6 compared to the oral saline group.. We suggest that 5-day administration of topical ACV, oral VACV and oral FCV are effective for mouse epithelial herpetic keratitis and sufficiently decrease HSV amounts in the ocular surface and eyeballs.

Topics: 2-Aminopurine; Acyclovir; Administration, Oral; Administration, Topical; Animals; Antiviral Agents; Disease Models, Animal; DNA Copy Number Variations; DNA, Viral; Epithelium, Corneal; Eye Infections, Viral; Famciclovir; Female; Herpesvirus 1, Human; Keratitis, Herpetic; Mice; Mice, Inbred C57BL; Real-Time Polymerase Chain Reaction; Tears; Trigeminal Nerve; Valacyclovir; Valine

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

Topics: Acyclovir; Antiviral Agents; Aqueous Humor; DNA, Viral; Drug Therapy, Combination; Eye Infections, Viral; Gene Dosage; Glucocorticoids; Humans; Keratitis, Herpetic; Male; Middle Aged; Prednisolone; Real-Time Polymerase Chain Reaction; Simplexvirus; Uveitis, Anterior; Valacyclovir; Valine

To report a case of Acute Retinal Necrosis (ARN)-developed nephrotoxicity during intravenous acyclovir treatment and toxic hepatitis during oral valacyclovir treatment.. Interventional case report.. Retrospective chart review.. A 45-year-old male with ARN treated with intravenous acyclovir developed nephrotoxicity. After switching to oral valacyclovir, toxic hepatitis developed. Both renal and liver function tests returned to normal levels after drug cessation. Although rare, clinicians should be aware of the potential nephrotoxic and hepatotoxic side effects of antiviral therapy during ARN treatment.

Topics: Acyclovir; Antiviral Agents; DNA, Viral; Eye Infections, Viral; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Middle Aged; Polymerase Chain Reaction; Renal Insufficiency; Retinal Necrosis Syndrome, Acute; Valacyclovir; Valine

Acute retinal necrosis (ARN) is an infectious retinitis primarily caused by the herpesviruses. Although the Epstein-Barr virus (EBV) has been implicated as a cause of ARN, to our knowledge, there has been no histopathologic documentation. We report the clinical history and histopathologic confirmation that EBV can cause ARN.. Clinical course and histopathology of a patient diagnosed with ARN caused by infection with EBV confirmed by molecular pathology.. Epstein-Barr virus is a recognized cause of intraocular inflammation and has been implicated as a possible cause of ARN. However, to our knowledge, tissue demonstration of EBV in a patient with ARN has not previously been reported. We identified the organism in the necrotic retina of a patient receiving immunosuppression because of idiopathic pulmonary fibrosis.

Topics: Acyclovir; Antibodies, Viral; Antigens, Viral; Antiviral Agents; Capsid Proteins; DNA, Viral; Epstein-Barr Virus Infections; Epstein-Barr Virus Nuclear Antigens; Eye Enucleation; Eye Infections, Viral; Female; Glucocorticoids; Herpesvirus 4, Human; Humans; Immunoglobulin G; Middle Aged; Retinal Necrosis Syndrome, Acute; Valacyclovir; Valine; Vitreous Body

Topics: Acyclovir; Aged; Antibodies, Viral; Antiviral Agents; Coloring Agents; Conjunctival Diseases; Eye Infections, Viral; Female; Herpes Simplex; Humans; Immunoglobulin G; Lissamine Green Dyes; Simplexvirus; Ulcer; Valacyclovir; Valine

To compare the outcomes of combination systemic and intravitreal antiviral therapy vs systemic antiviral therapy alone for treating acute retinal necrosis syndrome (ARN). We hypothesize that combination therapy might result in superior visual acuity (VA) and retinal detachment (RD) outcomes vs traditional systemic antiviral therapy alone.. A retrospective, interventional, comparative single-center study of patients with ARN. We reviewed demographic data, herpesvirus diagnoses, polymerase chain reaction (PCR) results, VA, RD, and the use of systemic and intravitreal antiviral therapy. Outcome measures included VA improvement by 2 or more lines, severe visual loss, VA ≤20/200, and RD.. We studied 29 eyes of 24 patients, treated from 1987 through 2009. Mean age was 42.6 years and mean follow-up was 44.0 months. Twelve patients (14 eyes) were treated with combined systemic and intravitreal antiviral therapy and 12 patients (15 eyes) with systemic therapy alone. Kaplan-Meier survival analysis revealed that patients receiving combination intravitreal and systemic antiviral therapy were more likely to have VA improved by 2 lines or greater (P=.006). Patients receiving combination therapy also showed a decreased incidence of progression to severe visual loss (0.13/patient-years [PY]) compared to patients receiving systemic therapy alone (0.54/PY, P=.02) and had decreased incidence of RD (0.29/PY vs 0.74/PY, P=.03).. Combination oral and intravitreal antiviral therapy may improve visual and functional outcomes in patients with ARN. Clinicians should consider prompt administration of combination systemic and intravitreal antiviral therapy as first-line treatment for patients with clinical features of ARN.

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

To describe the clinical characteristics, treatment, and outcomes of herpes simplex virus (HSV) infections of the cornea and adnexae to raise awareness and to improve management of this important eye disease in children.. Retrospective case series.. Fifty-three patients (57 eyes) 16 years of age or younger with HSV keratitis (HSK), HSV blepharoconjunctivitis (HBC), or both in an academic cornea practice.. The following data were collected: age at disease onset, putative trigger factors, coexisting systemic diseases, duration of symptoms and diagnoses given before presentation, visual acuity, slit-lamp examination findings, corneal sensation, dose and duration of medications used, drug side effects, and disease recurrence.. Presence of residual corneal scarring, visual acuity at the last visit, changes in corneal sensation, recurrence rate, and manifestations of HSK were assessed in patients receiving long-term prophylactic systemic acyclovir.. The median age at onset was 5 years. Mean follow-up was 3.6 years. Eighteen eyes had HBC only; 4 patients in this group had bilateral disease. Of 39 eyes with keratitis, 74% had stromal disease. Thirty percent of HSK cases were misdiagnosed before presentation. Seventy-nine percent of patients with keratitis had corneal scarring and 26% had vision of 20/40 or worse at the last visit. Eighty percent of patients had recurrent disease. Six of 16 patients (37%) receiving long-term oral acyclovir had recurrent HSV, at least one case of which followed a growth spurt that caused the baseline dosage of acyclovir to become subtherapeutic.. In a large series, pediatric HSK had a high rate of misdiagnosis, stromal involvement, recurrence, and vision loss. Oral acyclovir is effective, but the dosage must be adjusted as the child grows.

Topics: 2-Aminopurine; Acyclovir; Administration, Topical; Adolescent; Age of Onset; Anterior Eye Segment; Antiviral Agents; Blepharitis; Child; Child, Preschool; Conjunctivitis, Viral; Eye Infections, Viral; Famciclovir; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Infant; Keratitis, Herpetic; Male; Ointments; Retrospective Studies; Trifluridine; Valacyclovir; Valine; Vidarabine

To report a case of progressive outer retinal necrosis (PORN) presenting as a cherry red spot.. Case report.. A 53-year-old woman with recently diagnosed HIV and varicella-zoster virus (VZV) aseptic meningitis developed rapid sequential vision loss in both eyes over 2 months. Her exam showed a "cherry red spot" in both maculae with peripheral atrophy and pigmentary changes, consistent with PORN. Due to her late presentation and the rapid progression of her condition, she quickly developed end-stage vision loss in both eyes.. PORN should be considered within the differential diagnosis of a "cherry red spot." Immune-deficient patients with a history of herpetic infection who present with visual loss warrant prompt ophthalmological evaluation.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; AIDS-Related Opportunistic Infections; Antiretroviral Therapy, Highly Active; Antiviral Agents; Blindness; Disease Progression; Eye Infections, Viral; Female; Herpes Zoster Ophthalmicus; Humans; Middle Aged; Mucolipidoses; Retinal Necrosis Syndrome, Acute; Valacyclovir; Valine

Topics: Acyclovir; Anti-Infective Agents; Antiviral Agents; DNA, Viral; Drug Therapy, Combination; Epstein-Barr Virus Infections; Eye Infections, Viral; Fluorescein Angiography; Herpesvirus 4, Human; Humans; Infectious Mononucleosis; Male; Middle Aged; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Trimethoprim, Sulfamethoxazole Drug Combination; Valacyclovir; Valine; Vitreous Body

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

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

Topics: Acyclovir; Aged; Aged, 80 and over; DNA, Viral; Drug Therapy, Combination; Eye Infections, Viral; Female; Ganciclovir; Herpes Zoster Ophthalmicus; Herpes Zoster Vaccine; Herpesvirus 3, Human; Humans; Male; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Vaccination; Valacyclovir; Valine; Visual Acuity

To report a case of unilateral varicella zoster virus (VZV) retinal vasculitis aspect in an immunocompetent child without systemic infection. Clinically, no signs of retinal necrosis or frosted branch vasculitis were present. This is an observational case report. Quantitative PCR was performed on the aqueous humor (AH) using primers specific for herpes virus (cytomegalovirus, Epstein-Barr virus, herpes simplex virus 1-2, and VZV). The patient was treated with intravenous acyclovir, intravitreous ganciclovir, and oral valacyclovir. A positive quantitative PCR result was found for VZV DNA (1.72 x 10(6) viral copies/ml) in the AH. After 6 months, PCR of the AH was negative. Herpes viruses are involved in the pathogenesis of isolated retinal vasculitis. This case demonstrates that quantitative PCR is useful to detect viral DNA in AH and to monitor the viral activity and the therapeutic response.

Topics: Acyclovir; Antiviral Agents; Aqueous Humor; Child; DNA, Viral; Drug Administration Routes; Eye Infections, Viral; Female; Ganciclovir; Herpesvirus 3, Human; Humans; Photophobia; Polymerase Chain Reaction; Retinal Vasculitis; Treatment Outcome; Valacyclovir; Valine; Vision, Low

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

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

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

To investigate clinical manifestations and response to antiviral therapy of 8 patients with cytomegalovirus (CMV)-induced corneal endotheliitis who were diagnosed and treated at 2 university hospitals in Japan.. Retrospective, consecutive, multicenter case series.. Eight eyes of 8 patients diagnosed with active CMV corneal endotheliitis at Kyoto Prefectural University of Medicine and Ehime University School of Medicine. The diagnosis was made based on the detection by polymerase chain reaction assay of CMV, but not herpes simplex virus (HSV) and varicella zoster virus (VZV) DNA, in the aqueous humor from the affected eye.. Retrospective review of the clinical manifestations and responses to antiviral treatment.. Patient profiles, including duration of corneal endotheliitis, systemic disease, intraocular pressure, and clinical manifestation of anterior and posterior segments. The clinical response to systemic and topical antiviral treatment was evaluated by slit-lamp examination. Corneal endothelial density was examined by specular microscopy.. The average observation period after CMV detection was 10.4 months (range, 2-24 months). None of the patients had systemic immunodeficiency. Corneal manifestations included linear keratic precipitates associated with multiple coin-shaped lesions and local corneal stromal edema. Of the 8 patients, 4 had undergone penetrating corneal transplantation. Systemic ganciclovir therapy was used in 7 patients, and in 1 patient, valacyclovir was administered, with the corneal endotheliitis responding quickly to the early administration of galovir. At the final examination, 6 eyes had a clear cornea, but 2 eyes had bullous keratopathy.. Besides HSV and VZV, CMV must be considered as an etiologic agent in patients with corneal endotheliitis. Cytomegalovirus corneal endotheliitis may be a newly identified clinical entity of reactivated CMV in the anterior chamber of individuals free of accompanying systemic symptoms.

Topics: Acyclovir; Administration, Topical; Aged; Aged, 80 and over; Antiviral Agents; Aqueous Humor; Cell Count; Cytomegalovirus; Cytomegalovirus Infections; DNA, Viral; Endothelium, Corneal; Eye Infections, Viral; Female; Ganciclovir; Humans; Keratitis; Male; Middle Aged; Polymerase Chain Reaction; Retrospective Studies; Valacyclovir; Valine

Acute retinal necrosis (ARN) is a distinct ocular viral syndrome traditionally treated with intravenous acyclovir followed by oral acyclovir. We investigated the use of the oral antiviral medications valacyclovir and famciclovir as the sole treatment for patients with newly diagnosed ARN syndrome.. Retrospective, uncontrolled, interventional case series.. Eight consecutive patients with newly diagnosed ARN treated solely with oral antiviral medications.. All patients received famciclovir or valacyclovir without antecedent intravenous therapy. One patient with bilateral ARN treated with famciclovir received a single intravitreal injection of foscarnet in the more severely involved eye.. Clinically and photographically documented complete resolution of retinitis and best-corrected visual acuity on final follow-up.. Active retinitis resolved completely in 10/10 (100%) affected eyes. Initial response to treatment was seen as early as 4 days (in 5 eyes), with a median time to complete resolution of 14 days. At the last examination, visual acuity was improved (> or = 2 Snellen lines) in 6 (60%) eyes, stable in 2 (20%) eyes, and worse in 2 (20%) eyes. Over a mean follow-up of 36 weeks (range, 7-72 weeks), 3 eyes developed rhegmatogenous retinal detachment that was successfully repaired with 1 vitrectomy surgery. No patient with initially unilateral involvement developed disease in the contralateral eye.. In this pilot study, the use of the oral drugs valacyclovir and famciclovir resulted in complete regression of herpetic necrotizing retinitis. Additional studies are necessary to evaluate the role of these antiherpetic medications in the treatment of the ARN syndrome.

Topics: 2-Aminopurine; Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Eye Infections, Viral; Famciclovir; Female; Follow-Up Studies; Herpes Simplex; Herpes Zoster Ophthalmicus; Humans; Male; Pilot Projects; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Valacyclovir; Valine; Visual Acuity

Topics: 2-Aminopurine; Acyclovir; Administration, Oral; Antiviral Agents; Eye Infections, Viral; Famciclovir; Herpes Simplex; Herpes Zoster Ophthalmicus; Humans; Retinal Necrosis Syndrome, Acute; Valacyclovir; Valine; Visual Acuity

Topics: Acyclovir; Antiviral Agents; Eye Infections, Viral; Ganciclovir; Herpes Zoster; Humans; Retinal Necrosis Syndrome, Acute; Valacyclovir; Valganciclovir; Valine

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 case of an immunocompetent child with herpes simplex virus-2 (HSV-2) acute retinal necrosis (ARN) syndrome, who was considered to have an idiopathic unilateral panuveitis sensitive to steroid treatment.. Polymerase chain reaction for detection of viral DNA was applied to ocular fluids and in situ hybridization was performed on a retinal sample. HSV serology was performed using the ELISA and Western blot techniques, and an in-house indirect immunofluorescence technique.. In addition to the atypical clinical presentation, the serological assays for HSV were negative using ELISA at the time of diagnosis of ARN and 1 year after. HSV2 infection was confirmed by using polymerase chain reaction of aqueous humor specimen and in situ hybridization of a retinal biopsy. Retrospective analysis with the Western blot technique detected low titers of anti-HSV antibodies, when the sera were concentrated 5-fold.. Herpes virus infections must be investigated in children with posterior or panuveitis. PCR analysis is a reliable technique for diagnosis. This case emphasizes that clinical presentation can be atypical and that a negative viral serology does not exclude an acute or a past herpetic infection.

Topics: Acyclovir; Antibodies, Viral; Antiviral Agents; Aqueous Humor; Child, Preschool; Chronic Disease; DNA, Viral; Enzyme-Linked Immunosorbent Assay; Eye Infections, Viral; Herpes Simplex; Herpesvirus 2, Human; Humans; In Situ Hybridization; Male; Panuveitis; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Valacyclovir; Valine

Topics: Acyclovir; Adult; Antiviral Agents; DNA, Viral; Eye Infections, Viral; Herpesvirus 3, Human; Humans; Laser Coagulation; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Recurrence; Retinal Necrosis Syndrome, Acute; Stem Cell Transplantation; Transplantation, Homologous; Valacyclovir; Valine

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

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

Topics: Acyclovir; Administration, Oral; Adult; Aged; Antiviral Agents; Eye Infections, Viral; Herpes Simplex; Herpes Zoster Ophthalmicus; Humans; Male; Retinal Necrosis Syndrome, Acute; Valacyclovir; Valine

Topics: 2-Aminopurine; Abnormalities, Drug-Induced; Acyclovir; Amantadine; Antiviral Agents; Cidofovir; Contraindications; Cytosine; Drug Resistance, Microbial; Eye Infections, Viral; Famciclovir; Foscarnet; Ganciclovir; Guanine; Humans; Interferon-alpha; Kidney Diseases; Lamivudine; Organophosphonates; Organophosphorus Compounds; Prodrugs; Ribavirin; Rimantadine; Trifluridine; Valacyclovir; Valine; Virus Diseases