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Masako Chen, Emile Sharifi, Vicente Diaz, John Mauro, C. Michael Samson, Sanjay Kedhar; Combined systemic and intravitreal antiviral treatment in acute retinal necrosis. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4500.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the outcomes at our institution for treating acute retinal necrosis (ARN) with combined systemic and intravitreal antiviral agents.
Retrospective chart review of all patients seen at the largest tertiary care eye hospital in New York City from 2009 to 2014 identified with polymerase chain reaction (PCR) confirmed intraocular fluid for viral Herpes Simplex Virus (HSV1 or 2) and Varicella Zoster virus (VZV). Patients with ARN who were immunocompromised (AIDS, systemic malignancy, systemic immunosuppresion) or presented with no light perception in affected eye were excluded from this study. We report the outcomes by best-corrected visual acuity (BCVA) and development of retinal detachment (RD) at intervals of 2, 4, and 6 months of follow up.
Twenty-nine patients and thirty-one eyes met the inclusion criteria with median follow-up time of 15 months (range 6-45 months) and with a median age of 51 years at presentation (range 26-82 years). The study included 16 males and 13 females. At presentation, 5 eyes (16.1%) had best corrected visual acuity better than 20/40 and 9 eyes (29%) had best corrected visual acuity better than 20/200. Seventeen eyes (54.8%) presented at 20/200 or worse. Fifteen patients (54.2%) had VZV, 4 had HSV1 (16.7%) and 5 had HSV2 (20.8%), as identified by PCR. Ten eyes (32.3%) developed RD with mean time to RD of 54 days . By viral etiology, 6 of 15 eyes (40%) with VZV developed RD compared to 4 of 11 (36.4%) eyes with HSV, which was not a statistically significant difference (P=0.646). At 6 months follow-up, 6 eyes (19.4%) had BCVA better than 20/40, and 8 eyes (29%) had BCVA between 20/40 and 20/200. Sixteen eyes (51.6%) had BCVA worse than 20/200. At 6-months follow-up, the BCVA of 7 eyes improved at least 2 lines (22.6%), remained stable in 10 eyes (32.3%), and became worse in 11 eyes (35.5%). Two patients developed contralateral ocular involvement.
Combined systemic and intravitreal therapy yields results in our patient population that are comparable to other retrospective outcomes studies reported in the literature using just systemic antiviral treatment. Our results suggest a superior outcome when combined intravitreal and systemic treatment is used compared to monotherapy.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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