valacyclovir and Retinal-Detachment

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

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

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

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

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

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

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

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

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

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