Acute retinal necrosis
| Acute retinal necrosis | |
| Classification and external resources | |
| eMedicine | oph/377 |
|---|---|
| MeSH | D015882 |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [2].
Overview
Acute retinal necrosis is a type of retinitis which can be associated with viral infections.
It was first characterized in 1971.[1][2]
One study indicated an incidence of 1 per 1.6 to 2.0 million.[3]
Causes
The exact causes are not known, but varicella zoster virus is frequently implicated,[4] and other herpesviruses can be involved.[5]
Treatment
- Empiric antimicrobial therapy
- Alternative regimen (1): Acyclovir 10 mg/kg IV q8h for 1-2 weeks followed by Valacyclovir 1 g IV q8h for 6 weeks to several months followed by Acyclovir 400 mg PO bid for chronic maintenance
- Alternative regimen (2), unresponsive: Foscarnet 1.2-2.4 mg/0.1 mL intravitreal injection 1-3 times per week AND (Ganciclovir 5 mg/kg IV q12 for 2 weeks followed by 5 mg/kg q24h for 5-7 weeks OR Foscarnet 60 mg/kg IV q8h for 2 weeks followed by 90-120 mg/kg IV q24h OR Cidofovir 5 mg/kg IV for 2 weeks followed by 5 mg/kg IV q2weeks) followed by (Acyclovir 400 mg PO bid for chronic maintenance OR Valganciclovir 900 mg PO qd for chronic maintenance)
- Note: Ganciclovir is administered for patients with suspected CMV acute retinal necrosis. Whereas Foscarnet is administered for patients who are not immunocompromised
- Pathogen-directed antimicrobial therapy
- HSV or VZV
- Preferred regimen: Acyclovir 10 mg/kg IV q8h for 1-2 weeks followed by Acyclovir 400 mg PO bid for chronic maintenance
- Alternative regimen: Acyclovir 10 mg/kg IV q8h for 1-2 weeks followed by Valacyclovir 1 g IV q8h for 6 weeks to several months followed by Acyclovir 400 mg PO bid for chronic maintenance
- Cytomegalovirus
- Preferred regimen: Foscarnet 1.2-2.4 mg/0.1 mL intravitreal injection 1-3 times per week AND Ganciclovir 5 mg/kg IV q12 for 2 weeks followed by 5 mg/kg q24h for 5-7 weeks followed by Valganciclovir 900 mg PO qd for chronic maintenance
See also
References
- ↑ "eMedicine - Acute Retinal Necrosis : Article by Andrew A Dahl, MD". Archived from the original on 16 February 2008. Retrieved 2008-02-05.
- ↑ Urayama A, Yamada N, Sasaki T: Unilateral acute uveitis with retinal periarteritis and detachment. Jpn J Clin Ophthalmol 1971; 25: 607.
- ↑ Muthiah MN, Michaelides M, Child CS, Mitchell SM (2007). "Acute retinal necrosis: a national population‐based study to assess the incidence, methods of diagnosis, treatment strategies and outcomes in the UK". Br J Ophthalmol. 91 (11): 1452–5. doi:10.1136/bjo.2007.114884. PMC 2095441. PMID 17504853.
- ↑ Lau CH, Missotten T, Salzmann J, Lightman SL (2007). "Acute retinal necrosis features, management, and outcomes". Ophthalmology. 114 (4): 756–62. doi:10.1016/j.ophtha.2006.08.037. PMID 17184841.
- ↑ Kezuka T, Atherton SS (2007). "Acute retinal necrosis". Chem Immunol Allergy. Chemical Immunology and Allergy. 92: 244–53. doi:10.1159/000099275. ISBN 3-8055-8187-4. PMID 17264500.