Two Cases of Acute Retinal Necrosis Treated With Systemic Antiviral Drugs and Intravitreal Antiviral Injections

Ji-Wook Yang; Wung-Jae Kim; Young-Hoon Park

doi:10.3341/jkos.2009.50.5.794

Journal List > J Korean Ophthalmol Soc > v.50(5) > 1008564

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Yang, Kim, and Park: Two Cases of Acute Retinal Necrosis Treated With Systemic Antiviral Drugs and Intravitreal Antiviral Injections

Original Article

J Korean Ophthalmol Soc 2009;50(5):794-799.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.5.794

Two Cases of Acute Retinal Necrosis Treated With Systemic Antiviral Drugs and Intravitreal Antiviral Injections

Ji-Wook Yang, MD, Wung-Jae Kim, MD, Young-Hoon Park, MD

Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea

Address reprint requests to Young-Hoon Park, MD Department of Ophthalmology, Seoul St. Mary's Hospital, The Catholic University of Korea #505 Banpo-dong, Seocho-gu, Seoul 137-701, Korea Tel: 82-2-590-7464, Fax: 82-2-599-7405, E-mail: parkyh@catholic.ac.kr

Received 24 January 2008 Accepted 15 January 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report the use of intravitreal antiviral injections as adjunctive therapy in the managementof two immunocompetent patients with acute retinal necrosis.

Case summary

We performed two or three intravitreal injections of gancyclovir (2,000 μ g/0.05 ml) on two patients (two eyes) with acute retinal necrosis resistant to intravenous acyclovir therapy (1,500 mg/m²/day). Both patients received intravitreal antiviral injections for the treatment of retinitis that progressed despite standard intravenous acyclovir therapy. The retinitis resolved, and visual acuity improved after 18 months of follow-up in both cases.

Conclusions

Intravitreal antiviral injections may be a safe and efficacious adjunctive therapy in the management of patients with acute retinal necrosis resistant to intravenous acyclovir therapy.

Keywords: Acute retinal necrosis, Gancyclovir, Intravitreal injection

References

1. Holland GN. Standard diagnostic criteria for the acute retinal syndrome. Executive Committee of the American Uveitis Society. Am J Ophthalmol. 1994; 117:663–7.

2. Pepose JS, Gelder RN. Acute retinal necrosis syndrome. Ryan SJ, editor. Retina. 4th ed.St, Louis: Mosby;2006. 2:chap.p. 93.

3. Austin RB. Progressive outer retinal necrosis syndrome: a comprehensive review of its clinical presentation, relationship to immune system status, and management. Clin Eye Vis Care. 2000; 12:119–29.

4. Lau CH, Missotten T, Salzmann J, Lightman SL. Acute retinal necrosis features, management, and outcomes. Ophthalmology. 2007; 114:756–62.

5. Kim SJ, Yu HG. Bilateral acute retinal necrosis syndrome in the patient with acquired immunodeficiency syndrome. J Korean Ophthalmol Soc. 2003; 44:2445–50.

6. Duker JS, Blumenkranz MS. Diagnosis and management of the acute retinal necrosis (ARN) syndrome. Surv Ophthalmol. 1991; 35:327–43.

7. Ciulla TA, Rutledge BK, Morley MG, Duker JS. The progressive outer retinal necrosis syndrome: successful treatment with combination antiviral therapy. Ophthalmic Surg Lasers. 1998; 29:198–206.

8. Meffert SA, Kertes PJ, Lim PL, et al. Successful treatment of progressive outer retinal necrosis using highdose intravitreal ganciclovir. Retina. 1997; 17:560–2.

9. Yin PD, Kurup SK, Fischer SH, et al. Progressive outer retinal necrosis in the era of highly active antiretroviral therapy: successful management with intravitreal injections and monitoring with quantitative PCR. J Clin Virol. 2007; 38:254–9.

10. Luu KK, Scott IU, Chaudhry NA, et al. Intravitreal antiviral injections as adjunctive therapy in the management of immunocompetent patients with necrotizing herpetic retinopathy. Am J Ophthalmol. 2000; 129:811–3.

11. Chau Tran TH, Cassoux N, Bodaghi B, Lehoang P. Successful treatment with combination of systemic antiviral drugs and intravitreal ganciclovir injections in the management of severe necrotizing herpetic retinitis. Ocul Immunol Inflamm. 2003; 11:141–4.

12. Teich SA, Cheung TW, Friedman AH. Systemic antiviral drugs used in ophthalmology. Surv Ophthalmol. 1992; 37:19–53.

13. Field HJ. Herpes simplex virus antiviral drug resistance-current trends and future prospects. J Clin Virol. 2001; 21:261–9.

14. Coen DM, Fleming HE Jr, Leslie LK, Retondo MJ. Sensitivity of arabinosyladenine-resistant mutants of herpes simplex virus to other antiviral drugs and mappingof drug hypersensitivity mutations to the DNA polymerase locus. J Virol. 1985; 53:477–88.

15. Jacobson MA. Treatment of cytomegalovirus retinitis in patients with the acquired immunodeficiency syndrome. N Engl J Med. 1997; 337:105–14.

16. Vaudaux JD, Holland GN. Cytomegalovirus infections of the retina. Ryan SJ, editor. Retina. 4th ed.St, Louis: Mosby;2006. 2:chap.p. 91.

17. Young S, Morlet N, Besen G, et al. High-dose intravitreous ganciclovir in the treatment of cytomegalovirus retinitis. Ophthalmology. 1998; 105:1404–10.

18. Velez G, Roy CE, Whitcup SM, et al. High-dose intravotreal ganciclovir and foscarnet for cytomegalovirus retinitis. Am J Ophthalmol. 2001; 131:396–7.

19. Morlet N, Young S, Naidoo D, et al. High dose intravitreal ganciclovir injection provides a prolonged therapeutic intraocular concentration. Br J Ophthalmol. 1996; 80:214–6.

Figure 1.

Fundus photographs of 51-year-old female. (A) In initial presentations, fundus photographs shows disc swelling and multiple demarcated areas of retinal whitening. There are multiple, cream-colored, and confluent necrotic lesions and hemorrhage at posterior pole and periphery. Laser photocoagulation scars are also shown at temporal side (black arrow). (B) After the intravitreal gancyclovir injections (twice), disc swelling and multiple necrotic lesions have diminished.

Figure 2.

The fundus photographs and fluorescein angiograph of 53-year-old female. (A), (B) In initial presentations, disc swelling and multiple necrotic areas of retina are shown. In fluorescein angiogram, late staining of retinal vessels and disc staining are shown. (C) After 5 days of intravenous acyclovir injections. Despite intravenous acyclovir, multiple necrotic areas of retina and vitritis increase. (D) After 2 days of the third intravitreal gancyclovir injection. Multiple necrotic areas of retina and vitritis decrease.

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