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A. Aizman, M.W. Johnson, S.G. Elner; Successful Treatment of Acute Retinal Necrosis Syndrome With Oral Antiviral Medications . Invest. Ophthalmol. Vis. Sci. 2005;46(13):1038.
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Purpose: Acute retinal necrosis (ARN) is a distinct ocular viral syndrome traditionally treated with intravenous acyclovir followed by oral acyclovir. We investigated the use of oral antivirals (valacyclovir and famciclovir) as a primary treatment for patients newly diagnosed with ARN. Methods: Retrospective, interventional case series. Six patients with newly diagnosed ARN received oral famciclovir or valacyclovir as a sole treatment.One patient with bilateral ARN (BARN) treated with oral famciclovir received a single intravitreal injection of foscarnet in the more severely involved eye. Measured outcomes included photographically documented regression of viral retinitis, best–corrected visual acuity, and secondary complications. Results: Signs of active retinitis resolved completely in 8/8 (100%) affected eyes. Definite response to treatment was seen as early as 4 days (in 3 eyes), with a mean time to complete resolution of 16 days. At the last examination, the visual acuity was improved ( 2 or more Snellen lines) in 5/8 (63%) eyes, stable in 2 (25%) eyes, and worse in 1 (12%) eye. Over a mean follow–up of 22 weeks (range, 6–52 weeks), one patient developed a retinal detachment that was successfully repaired with one procedure. Conclusions: In our series, the oral anti–herpetic drugs famciclovir and valacyclovir appear to be effective for the initial treatment of ARN. Due to their favorable efficacy and safety profile, they may be considered as first–line therapy in eyes without lesions immediately threatening the macula or optic nerve.
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