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Open Access Highly Accessed Research article

Valacyclovir in the treatment of acute retinal necrosis

Simon RJ Taylor123*, Robin Hamilton3, Claire Y Hooper3, Lavnish Joshi24, Jiten Morarji2, Nitin Gupta3 and Sue L Lightman34

Author Affiliations

1 Division of Immunology & Inflammation, Faculty of Medicine, Imperial College London, London, UK

2 Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK

3 Moorfields Eye Hospital, London, UK

4 UCL Institute of Ophthalmology, London, UK

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BMC Ophthalmology 2012, 12:48  doi:10.1186/1471-2415-12-48

Published: 5 September 2012

Abstract

Background

To report the outcome of oral valacyclovir as the sole antiviral therapy for patients with acute retinal necrosis (ARN).

Methods

This study reports a retrospective, interventional case series of nine consecutive patients with ten eyes with newly diagnosed ARN treated with oral valacyclovir as the sole antiviral agent. Eight patients received oral valacyclovir 2 g tid (Valtrex, GlaxoSmithKline) and one patient with impaired renal function received oral 1 g tid. The main outcome measures were response to treatment, time to initial response to treatment, time to complete resolution of retinitis, best corrected visual acuity (BCVA) at final follow-up, retinal detachment and development of recurrent or second eye disease.

Results

Retinitis resolved in ten of ten (100%) affected eyes. The median time to initial detectable response was seven days and the median time to complete resolution was 21 days. A final BCVA of 20/40 or better was achieved in 6/10 (60%) of eyes. 3/10 eyes (30%) developed a retinal detachment. No patients developed either disease reactivation or second eye involvement over the course of the study (mean follow up 31 weeks, range 7 to 104 weeks).

Conclusions

Treatment with oral valacyclovir as the sole antiviral therapy resulted in complete resolution of retinitis. Final BCVA and retinal detachment rate were comparable with previously reported outcomes for intravenous acyclovir.

Keywords:
Acute retinal necrosis; Herpetic retinitis; Acyclovir; Valacyclovir