Treatment of acute retinal necrosis syndrome with oral antiviral medications

Ophthalmology. 2007 Feb;114(2):307-12. doi: 10.1016/j.ophtha.2006.06.058. Epub 2006 Nov 21.


Objective: Acute retinal necrosis (ARN) is a distinct ocular viral syndrome traditionally treated with intravenous acyclovir followed by oral acyclovir. We investigated the use of the oral antiviral medications valacyclovir and famciclovir as the sole treatment for patients with newly diagnosed ARN syndrome.

Design: Retrospective, uncontrolled, interventional case series.

Participants: Eight consecutive patients with newly diagnosed ARN treated solely with oral antiviral medications.

Intervention: All patients received famciclovir or valacyclovir without antecedent intravenous therapy. One patient with bilateral ARN treated with famciclovir received a single intravitreal injection of foscarnet in the more severely involved eye.

Main outcome measures: Clinically and photographically documented complete resolution of retinitis and best-corrected visual acuity on final follow-up.

Results: Active retinitis resolved completely in 10/10 (100%) affected eyes. Initial response to treatment was seen as early as 4 days (in 5 eyes), with a median time to complete resolution of 14 days. At the last examination, visual acuity was improved (> or = 2 Snellen lines) in 6 (60%) eyes, stable in 2 (20%) eyes, and worse in 2 (20%) eyes. Over a mean follow-up of 36 weeks (range, 7-72 weeks), 3 eyes developed rhegmatogenous retinal detachment that was successfully repaired with 1 vitrectomy surgery. No patient with initially unilateral involvement developed disease in the contralateral eye.

Conclusions: In this pilot study, the use of the oral drugs valacyclovir and famciclovir resulted in complete regression of herpetic necrotizing retinitis. Additional studies are necessary to evaluate the role of these antiherpetic medications in the treatment of the ARN syndrome.

Publication types

  • Case Reports

MeSH terms

  • 2-Aminopurine / analogs & derivatives*
  • 2-Aminopurine / therapeutic use
  • Acyclovir / analogs & derivatives*
  • Acyclovir / therapeutic use
  • Administration, Oral
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antiviral Agents / therapeutic use*
  • Eye Infections, Viral / drug therapy*
  • Eye Infections, Viral / virology
  • Famciclovir
  • Female
  • Follow-Up Studies
  • Herpes Simplex / drug therapy*
  • Herpes Simplex / virology
  • Herpes Zoster Ophthalmicus / drug therapy*
  • Herpes Zoster Ophthalmicus / virology
  • Humans
  • Male
  • Pilot Projects
  • Retinal Necrosis Syndrome, Acute / drug therapy*
  • Retinal Necrosis Syndrome, Acute / virology
  • Retrospective Studies
  • Valacyclovir
  • Valine / analogs & derivatives*
  • Valine / therapeutic use
  • Visual Acuity


  • Antiviral Agents
  • 2-Aminopurine
  • Valine
  • Valacyclovir
  • Famciclovir
  • Acyclovir