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B. Meghpara, G. Sulkowski, M. R. Kesen, H. H. Tessler, D. A. Goldstein; Long Term Follow-Up of Patients With Necrotizing Herpetic Retinitis. Invest. Ophthalmol. Vis. Sci. 2009;50(13):6037.
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To examine long term visual outcomes in patients with necrotizing herpetic retinitis treated in one center.
Medical records of patients clinically diagnosed with either acute retinal necrosis (ARN) or progressive outer retinal necrosis (PORN) at the University of Illinois at Chicago uveitis service between 1998 and 2007 were reviewed. Medical, demographic, and treatment data were recorded. Visual acuity (VA) and clinical exam findings were recorded at presentation and subsequent follow up periods (1 week, 1 month, 3 months, 6 months, 1 year, 2 year, 3 year, and last available follow-up).
36 patients were diagnosed with necrotizing herpetic retinitis between 1998 and 2007. 22 patients (28 eyes) had at least 1 follow-up visit and available medical records. Intravitreal injections of ganciclovir and/or foscarnet were administered in 14 of 28 of eyes. The mean number of injections given per eye was 3.57 (range 1-10) over an average course of 107 days (range 1-720). Intravenous and oral antiviral medications were used in 16 of 22 and 21 of 22 of patients respectively. Mean time to disease inactivity in eyes treated with intravitreal antiviral medication was 47 ± 45.6 days (range 10-174) compared to 61 ± 51 days (range 9-154) in patients receiving systemic treatment alone. 11 of 28 eyes had less than 25% of retina involved, 9 of 28 had 25-50%, and 8 of 28 had greater than 50%. Mean VA at initial presentation and all subsequent follow-up intervals was best when retinitis involved less than 25% of retina and decreased as area of retinal involvement increased. All patients with >50% retinal involvement experienced decreased vision, regardless of treatment modality. 4 of 5 patients with 25-50% of retina affected who were treated with intravitreal antivirals showed an improvement in VA of at least two snellen lines, whereas 1 of 2 patients with similar retinal involvement showed a two snellen line improvement of visual acuity following systemic treatment. 8 of 28 eyes developed retinal detachment. None of the six eyes that underwent prophylactic laser treatment developed retinal detachment with a mean of one year follow-up (range 10-1330 days).
Greater extent of retinitis portends a worse prognosis. Although intravitreal treatment did not improve outcomes in patients with severe disease, those patients with moderate disease (25-50% of retina involved) showed some improvement in visual acuity. In addition, the use of prophylactic laser treatment decreased the likelihood of retinal detachment.
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