From the Research
The treatment protocol for acute retinal necrosis (ARN) should involve immediate antiviral therapy with oral valacyclovir, as it has been shown to be clinically equivalent to intravenous acyclovir therapy 1. This approach is crucial because ARN is caused by herpesviruses (usually varicella-zoster virus or herpes simplex virus) and can rapidly progress to severe vision loss if not treated promptly. Some key points to consider in the treatment of ARN include:
- The use of oral valacyclovir as an outpatient therapy, with or without intravitreal foscarnet, as an acceptable alternative to inpatient therapy required for intravenous treatment 1
- The potential benefits of adding systemic corticosteroids, such as oral prednisone, to reduce inflammation after initiating antiviral therapy
- The importance of prophylactic laser photocoagulation to prevent retinal detachment, which occurs in up to 75% of cases
- The need for close monitoring with frequent ophthalmologic examinations to assess treatment response and detect complications early
- The consideration of vitreoretinal surgery for patients who develop retinal detachment despite preventive measures
- The monitoring of the fellow eye, as bilateral involvement can occur in 30-70% of untreated cases, and the potential recommendation of prophylactic antiviral therapy to protect the unaffected eye. According to the most recent and highest quality study, a systematic review and meta-analysis published in 2024, the overall pooled estimated proportions of visual acuity improvement, recurrence, and retinal detachment were 37% (95% CI: 27-47%), 14% (95% CI: 8-21%), and 43% (95% CI: 38-50%), respectively 2. However, the study from 2018 provides the most relevant comparison of treatment outcomes, showing that oral valacyclovir is clinically equivalent to intravenous acyclovir therapy 1.