Antiviral selection in the management of acute retinal necrosis

Patrick MK Tam¹, Claire Y Hooper², Susan Lightman²

¹Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, N.T., Hong Kong, People’s Republic of China; ²Institute of Ophthalmology, Moorfields Eye Hospital, London, UK

Abstract: There is no consensus on the optimal antiviral regimen in the management of acute retinal necrosis, a disease caused by herpetic viruses with devastating consequences for the eye. The current gold standard is based on retrospective case series. Because the incidence of disease is low, few well-designed, randomized trials have evaluated treatment dosage and duration. Newer oral antiviral agents are emerging as alternatives to high-dose intravenous acyclovir, avoiding the need for inpatient intravenous treatment. Drug resistance is uncommon but may also be difficult to identify. Antiviral drugs have few side effects, but special attention needs to be paid to patients who have underlying renal disease, are pregnant or are immunocompromised.

Keywords: acute retinal necrosis, acyclovir, herpes, retinitis