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S. Yeh, E. B. Suhler, J. R. Smith, J. T. Rosenbaum, J. T. Stout, A. K. Lauer, D. J. Wilson, C. J. Flaxel; Clinical Outcomes of Acute Retinal Necrosis Treated With Systemic Antiviral versus Combination Systemic and Intravitreal Antiviral Therapy. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2406.
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Acute retinal necrosis (ARN) is a severe, full-thickness retinitis attributed to herpes virus reactivation with subsequent vitreous and retinal inflammation. Systemic and local anti-viral therapies are available for herpes virus infections; however, retinal detachment occurs frequently in patients with ARN and may result in poor visual outcomes. The purpose of this study was to determine whether systemic antiviral or combination systemic plus intravitreal antiviral therapy was more efficacious in the clinical outcomes of ARN.
Retrospective, comparative, case series. Demographic data (age, gender), laterality, associated systemic herpes virus diagnoses, retinal detachment, surgical procedure(s) performed, systemic antiviral (acyclovir, valacyclovir, or famciclovir) and intravitreal therapy (foscarnet) were recorded. Patients with ARN were classified into presumptive, probable, and definite ARN based on 1) clinical features of ARN (presumptive), 2) clinical characteristics plus history of systemic herpes infection (probable) and 3) polymerase chain reaction confirmation of herpes virus from ocular fluid (definite).
17 eyes of 15 patients with ARN were identified. There were 1 presumptive, 6 probable, and 8 definite ARN diagnoses. Mean age was 47.3 years (range 13-85) and mean follow-up time was 31.4 months (range 3-120 months)6 eyes were treated with systemic anti-viral therapy alone whereas 11 eyes were treated with combination therapy. 6 eyes (35%) underwent retinal detachment repair surgery. 4 eyes required more than one surgery, but all eyes were attached at final follow-up. 2 eyes (12%) were phthisical at final follow-up. No differences in the frequency of retinal detachment, phthisis, or severe visual acuity (VA) loss (final VA 2 Snellen lines) in the combination therapy group whereas mean logMAR VA decreased from 0.80+/-1.16 to 0.89 +/- 1.12 units (i.e. loss of < 1 Snellen line, p < 0.21 for combination vs. systemic VA change).
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