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Julijana Baltinas, Susan Lightman, Peter J McCluskey, Oren Tomkins-Netzer; Similar outcomes for oral and intravenous treatment of acute retinal necrosis. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3611. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Acute retinal necrosis (ARN) is a rare form of herpetic uveitis which requires intensive systemic anti-viral treatment. There are different treatment approaches to ARN, but their clinical outcome remains unclear. We reviewed a large retrospective case series to compare the clinical outcome of patients treated with either intravenous (IV) acyclovir or oral valaciclovir therapy.
Patients were identified from records at Moorfields Eye Hospital, London, UK. Data was collected regarding presentation and subsequent visits including: signs, symptoms, treatments, LogMAR visual acuity (VA), development of retinal detachment (RD), and ocular complications. Cases of ARN were diagnosed clinically and confirmed by vitreous biopsies, where available. Only cases with a minimum of 6 months follow-up were selected for analysis. Multivariate linear regression and logistic regression methods were used to test for differences in outcomes between the two treatment groups.
50 eyes with ARN were identified (average age 52 years) in a total of 46 patients from 1992-2014. ARN was diagnosed clinically in 16 cases (32%), biopsies confirmed 30 eyes with varicella zoster (60%) and 4 with herpes simplex (8%). Forty two percent of cases were female. Twenty six cases (52%) were treated with oral valaciclovir and 24 (48%) with IV acyclovir. Intravitreal foscarnet was used as adjunctive treatment in 65% of oral cases (17/26) and 25% of IV cases (6/24). Mean VA at diagnosis was slightly worse for the IV group (1.1 vs 0.9 LogMAR, p value, p=0.38). At 1 month VA improved to 0.9 LogMAR for the IV group and remained 0.9 LogMAR in the oral group (p=0.08). Mean VA worsened in both groups at 6 months (to 1.1 vs 1.2 LogMAR respectively, p=0.13) and 1 year (to 1.2 and 1.5 LogMAR respectively, p=0.17). Both groups recorded poor visual outcomes, with severe vision loss (VA ≥1.0 LogMAR) observed in 50% of the IV group and 54% of the oral group at final review within 1 year (p=0.79). 66% of eyes developed RD at a mean of 116 days post diagnosis, occurring in 67% (16/24) of the IV cases and 65% (17/26) of the oral treatment group (p=0.85).
ARN results in significant deterioration in vision in a majority of patients, with up to two thirds developing retinal detachment. Systemic treatment with oral valaciclovir resulted in outcome comparable to IV acyclovir and can be considered as an alternative treatment approach.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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