J Korean Ophthalmol Soc.  2009 May;50(5):794-799. 10.3341/jkos.2009.50.5.794.

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

• Yang JW
• Kim WJ
• Park YH

• KMID: 2212327
• DOI: http://doi.org/10.3341/jkos.2009.50.5.794

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 microg/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.

Keyword

Acute retinal necrosis; Gancyclovir; Intravitreal injection

MeSH Terms

Acyclovir
Antiviral Agents
Follow-Up Studies
Ganciclovir
Humans
Intravitreal Injections
Retinal Necrosis Syndrome, Acute
Retinitis
Visual Acuity
Acyclovir
Antiviral Agents
Ganciclovir

Figure

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  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.

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  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.

Reference

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