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Emile Sharifi, Masako Chen, Diaz Vicente, John Mauro, C Michael Samson, Sanjay Kedhar; Combined systemic and intravitreal antiviral treatment in acute retinal necrosis. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3130.
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To determine the outcomes at our institution for treating acute retinal necrosis (ARN) with combined systemic and intravitreal antiviral agents.
A retrospective chart review was undertaken of all patients seen at the largest tertiary eyecare hospital in New York City from 2011 onward. Patients were identified by polymerase chain reaction (PCR) confirmation of intraocular fluid for viral Herpes Simplex Virus (HSV1 or 2) and Varicella Zoster virus (VZV) and exam findings consistent with ARN. All patients received combined intravitreal and systemic antiviral treatment. Patients who were immunocompromised (AIDS, systemic malignancy, systemic immunosuppresion) or presented with no light perception in the affected eye were excluded. We report the outcomes by best corrected visual acuity (BCVA) at 6 months and development of retinal detachment (RD).
Twelve patients and thirteen eyes met the criteria with median follow-up time of 11 months (range 6-45 months) and with a median age of 53 years at presentation (range 26-82 years). The majority (8 of 12) of patients were male. At presentation, 2 eyes (15.4%) had best corrected visual acuity better than 20/40 and 5 eyes (38.5%) had best corrected visual acuity better than 20/200. Seven (58.3%) patients had VZV, three had HSV2 (25%), and two had HSV1 (16.7%). Eight eyes (61.5%) developed retinal detachments. By viral etiology, six of eight eyes (75%) with VZV developed RD compared to 2 of 5 (40%) eyes with HSV, which was not a statistically significant difference (P= 0.29). Three eyes (23.0%) had best corrected visual acuity better than 20/40, and 8 eyes (61.5%) had best corrected visual acuity better than 20/200. Excluding the eye that presented with 20/25 vision, the best corrected visual acuity of 6 eyes (50%) improved by at least 2 lines, was stable in 4 eyes (33.3%), and was worse in 2 eyes (16.7%). One patient developed contralateral ocular involvement.
Combined systemic and intravitreal therapy yields results in our patient population that are at least comparable to other retrospective outcomes studies using just systemic antivitreal treatment. Notably, our inclusion criterion of PCR positive viral disease may bias to more severe disease. A larger, prospective, randomized study is needed to answer the question if there is additional therapeutic benefit to intravitreal antivirals being added to systemic treatment.
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