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Treatment of Refractory Acute Retinal Necrosis with Intravenous Foscarnet or Cidofovir

Tomasz P Stryjewski1,2, Nathan L Scott2, Miriam B Barshak1,2

  • 1a Massachusetts Eye and Ear Infirmary , Boston , Massachusetts , USA.

Ocular Immunology and Inflammation
|September 7, 2016
PubMed
Abstract

Insights

For acute retinal necrosis (ARN) unresponsive to acyclovir, intravenous foscarnet or cidofovir may be effective treatments. These antiviral medications offer hope for patients with refractory herpes simplex virus (HSV) or varicella zoster virus (VZV) ARN.

Area of Science:

  • Ophthalmology
  • Virology
  • Infectious Diseases

Background:

  • Acute Retinal Necrosis (ARN) is a severe ocular condition often caused by herpes simplex virus (HSV) or varicella zoster virus (VZV).
  • Standard antiviral treatment with acyclovir may be insufficient for refractory cases, necessitating alternative therapeutic strategies.

Observation:

  • This study reviewed four immunocompetent male patients diagnosed with ARN between 2008 and 2014.
  • Patients presented with ARN despite antiviral prophylaxis or treatment, indicating therapeutic challenges.

Findings:

  • One patient with recurrent HSV ARN refractory to acyclovir and foscarnet showed improvement with intravenous cidofovir.
  • Two patients with varicella zoster virus (VZV) ARN and one with HSV ARN responded favorably to intravenous foscarnet after initial or worsening disease on acyclovir.

Implications:

  • Intravenous foscarnet and cidofovir represent viable treatment options for ARN cases that do not respond to standard acyclovir therapy.
  • These findings expand treatment possibilities for severe viral retinitis, potentially improving visual outcomes in challenging cases.
Keywords:
Acute retinal necrosiscidofovirfoscarnetherpes simplex virusherpes zoster virus

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