Mid–Term Visual Outcome of Patients Presenting With Necrotizing Viral Retinopathies

Abstract

Abstract: : Purpose: To determine the mid–term outcome of patients presenting with necrotizing viral retinopathies treated with sustained antiviral drugs. Methods: Clinical records of patients referred between May 1997 and May 2000 for the therapeutic management of necrotizing viral retinopathies were analyzed. Occurrence of ocular complications and modalities of antiviral therapy were reported. Molecular analysis of ocular fluids was performed during each relapse or ocular inflammation in order to exclude a new onset of viral replication. Results: Twenty four eyes of 20 patients were included in this retrospective study. Mean age was 43,6 years (11–82 yo) and F/M ratio was 1. Retinitis was unilateral in 16 cases. Viral infection was confirmed in 15 cases initially or during the follow–up. Antiviral strategy included iv acyclovir in 14 cases, iv ganciclovir or foscarnet in 17 cases and intravitreal injections of ganciclovir in 6 cases. Retinal cicatrisation was achieved after a mean period of 2,5 weeks (1–3 weeks). Oral acyclovir or valacyclovir were used as a maintenance regimen in all patients. Ocular complications included relapse of retinitis (5 eyes), cataract (12 eyes), retinal detachment (9 eyes), chronic vitritis with macular edema (7 eyes), optic atrophy (5 eyes), epimacular membrane (4 eyes) or phtysis bulbi (3 eyes). Interferon alpha was used as an immunomodulatory agent in 4 cases. At the last examination, antiviral prophylaxis was discontinued only in 2 cases. No side effect was reported in patients treated with oral acyclovir. The mean follow–up was 5,3 years (2–13 years). Conclusions: Sustained antiviral therapy seems to reduce the risk of secondary viral reactivation. Ocular inflammation may occur during the follow–up without significant viral replication. Due to its antiviral and immunomodulatory activities, interferon alpha is an interesting option in severe cases. Further studies are needed to define modalities of antiviral tapering and discontinuation.

Keywords: retinitis • antiviral drugs • inflammation