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M9480079.TXT
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1994-08-09
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Document 0079
DOCN M9480079
TI [Bilateral acute retinal artery necrosis--healing of the second affected
eye]
DT 9410
AU Kalman A; Vogt M; Bernasconi E; Gloor B; Augenklinik,
Universitatsspitales Zurich.
SO Klin Monatsbl Augenheilkd. 1994 Apr;204(4):235-40. Unique Identifier :
AIDSLINE MED/94293569
AB BACKGROUND: The acute retinal necrosis syndrome (ARN) is caused by the
Varicella zoster virus or the Herpes simplex virus. However the dosage
and duration of the antiviral therapy for prevention of an infection in
the second eye or treatment of an infection on an affected fellow eye is
still not known. We discuss the timing of a possible steroid treatment
and demonstrate in a case report how an acute retinal necrosis syndrome
in a fellow eye was successfully treated. PATIENT: First eye: A
27-year-old not immunocompromised patient (HIV-negative) showed 2 months
after a febrile state an acute iritis in the right eye. 14 days later an
acute retinal necrosis syndrome was observed. The patient received
Acyclovir 3 x 750 mg i.v. for 6 days, and afterwards 5 x 200 mg orally
for 5 days. The patient developed an inoperable retinal detachment
despite therapy. Second eye: Eight days later the fellow eye developed a
localized retinal necrosis. Varicella zoster DNA was found in the
aqueous humor using the polymerase chain reaction (PCR). The antiviral
therapy with Acyclovir was increased from 1.1 g q 12 h (2 x 15 mg/kg/d)
to 1.0 g q 8 h (3 x 12.5 mg/kg/d). After 4 weeks the i.v. therapy was
followed by an oral therapy of 5 x 800 mg for 12 weeks. This dosage was
reduced to 5 x 400 mg for another 12 weeks. The oral therapy with
corticosteroids started on the 11th day with 100 mg Prednisone, in
slowly reducing dosage during 18 weeks. The fellow eye recovered fully
with a visual acuity of 20/20 after 6 months. CONCLUSION: The disease
started in the fellow eye with an acute iritis and a secondary glaucoma.
These symptoms can be a characteristic prodroma of an acute retinal
necrosis syndrome caused by a varicella zoster- or Herpes simplex virus
infection, which was not recognized first. Whether a long-term therapy
(as described above) is necessary or not is unclear on the basis of a
single case report, but we currently recommend the high-dose treatment
regimen until further data emerge.
DE Acyclovir/*ADMINISTRATION & DOSAGE Administration, Oral Adult Case
Report Dose-Response Relationship, Drug Drug Administration Schedule
English Abstract Fluorescein Angiography Follow-Up Studies Herpes
Zoster Ophthalmicus/DIAGNOSIS/*DRUG THERAPY Herpesvirus 3,
Human/ISOLATION & PURIF Human Infusions, Intravenous Intraocular
Pressure/DRUG EFFECTS Male Recurrence Retinal Necrosis Syndrome,
Acute/DIAGNOSIS/*DRUG THERAPY Visual Acuity/DRUG EFFECTS JOURNAL
ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).