valacyclovir and Retinitis

To report choroidal involvement in a case of ARN.. A 26-year-old immunocompetent female presented with a history of decreased vision in the right eye for 4 days. The best corrected visual acuity in the right eye was 3/60. Anterior segment examination showed circumciliary congestion, endothelial pigments, and 1+ cells in the anterior chamber. Fundus examination revealed mild vitritis, disc edema, multifocal patchy retinitis lesions involving the fovea and mid periphery, and arteriolitis. OCT revealed an RPE bump at the macula corroborating with hypocyanacent lesions on indocyanine angiography, which persisted till the late phase, indicating choroidal involvement. The patient was started on oral valacyclovir and oral steroids. Additionally, intravitreal ganciclovir injection was added, leading to a favorable outcome. The final visual acuity post silicone oil removal was 6/60.. This is a unique case of ARN having choroidal involvement along with the previously described classical features.

Topics: Adult; Choroid; Female; Fluorescein Angiography; Humans; Retinal Necrosis Syndrome, Acute; Retinitis; Valacyclovir

Acute retinal necrosis is a rare, sight-threatening condition typically found in immunocompromised patients and is most commonly caused by varicella zoster virus. Because of the poor prognosis and rapid progression of the disease course, prompt antiviral management is paramount.. A case report of acute retinal necrosis in a patient with herpes virus infection after a cervical epidural corticosteroid injection was performed. Extensive laboratory work and frequent follow-ups are necessary for management. This case report outlines the clinical signs of acute retinal necrosis and discusses the appropriate referrals and treatment needed to improve prognosis.. A 63-year-old man presented to our eye clinic with symptoms of pain and light sensitivity. Examination revealed anterior uveitis, vitritis, optic disc edema, macular edema, vasculitis, and retinitis of the left eye. The serum antibody test results showed abnormal ranges for varicella zoster virus and herpes simplex virus type 1, and the patient was diagnosed with acute retinal necrosis. Treatment prescribed by a retina specialist included oral valacyclovir and later oral prednisolone, for which the patient responded well before developing the common complication of retinal detachment.. The progressive nature of acute retinal necrosis is usually debilitating to vision, even when managed properly. Because prognosis is often poor, it is important to make proper diagnoses combined with a complete review of the patient's medical history and immune status to prevent further vision loss.

Topics: Antiviral Agents; Herpesvirus 3, Human; Humans; Male; Middle Aged; Prednisolone; Retinal Necrosis Syndrome, Acute; Retinitis; Valacyclovir

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

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

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

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