March 2012
Volume 53, Issue 14
ARVO Annual Meeting Abstract  |   March 2012
Systemic vs. Combination Antiviral Therapy and Retinal Outcomes in Acute Retinal Necrosis
Author Affiliations & Notes
  • Stephanie K. cramer
    Ophthalmology, Casey Eye Institute, Portland, Oregon
  • Christina Flaxel
    Ophthalmology, Casey Eye Institute, Portland, Oregon
  • Steven Yeh
    Ophthalmology, Emory Eye Center, Decatur, Georgia
  • Footnotes
    Commercial Relationships  Stephanie K. cramer, None; Christina Flaxel, None; Steven Yeh, None
  • Footnotes
    Support  An Unrestricted grant from Research to Prevent Blindness (New York, NY) to the Casey Eye Institute (Portland, OR) and the Emory Eye Center (Atlanta, GA)
Investigative Ophthalmology & Visual Science March 2012, Vol.53, 6216. doi:
  • Views
  • Share
  • Tools
    • Alerts
      This feature is available to authenticated users only.
      Sign In or Create an Account ×
    • Get Citation

      Stephanie K. cramer, Christina Flaxel, Steven Yeh; Systemic vs. Combination Antiviral Therapy and Retinal Outcomes in Acute Retinal Necrosis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6216.

      Download citation file:

      © ARVO (1962-2015); The Authors (2016-present)

  • Supplements

To evaluate the difference in retinal and anatomic outcomes in patients with acute retinal necrosis (ARN) who were treated with combination systemic antiviral plus intravitreal foscarnet versus systemic antiviral therapy alone.


A retrospective, comparative single-center study of patients with ARN was performed. Demographic data, herpesvirus diagnoses, polymerase chain reaction (PCR) results, retinal detachment (RD) rates , surgical repairs, and antivirals (systemic and intravitreal), were reviewed. The outcomes assessed were rates of retinal detachment, risks of eyes progressing to retinal detachment, time to retinal detachment, method of retinal detachment repair, and final state of the retina.


32 eyes in 27 patients with ARN were treated. The mean age was 43.1 years and the mean follow-up was 49.0 months. 16 eyes received combination and 16 eyes received systemic therapy alone. 16 eyes (50%) developed retinal detachments during follow-up. Six eyes (35%) detached in the combination therapy group and nine eyes detached in the systemic therapy alone group (60%). Kaplan-Meier survival analysis was highly suggestive of a trend towards a decreased incidence of retinal detachment in patients treated with combination antiviral therapy when compared to systemic antiviral therapy alone. Retinal detachments occurred with an incidence of 0.24 per eye-year in the combination therapy group and 0.77 per eye-year in the systemic antiviral therapy alone group (p=0.005). Oral prednisone was associated with decreased risk of retinal detachment in both the univariate (and multivariate) logistic regression model. Risk factors, which were not statistically associated with retinal detachment in the univariate regression model included intravitreal foscarnet, laser retinopexy, female sex, duration of symptoms and initial logMAR VA (p>0.10 for all factors except for intravitreal foscarnet.


This study suggests combination therapy of systemic antivirals and intravitreal foscarnet for ARN may lead to reduced rates of retinal detachment verses systemic therapy alone. Oral prednisone may also be associated with decreased rates of retinal detachment in ARN. Multiple procedures may be required in ARN patients to repair retinal detachments, and silicone oil removal should be performed judiciously.

Keywords: retinal detachment • retinitis • herpes simplex virus 

This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.