From the Guidelines
The treatment protocol for acute retinal necrosis (ARN) involves immediate intravenous acyclovir at 10-15 mg/kg every 8 hours for 7-10 days, followed by oral antiviral therapy for 3-6 months. The oral options include valacyclovir 1g three times daily, famciclovir 500mg three times daily, or acyclovir 800mg five times daily 1. Some key points to consider in the treatment of ARN include:
- Systemic corticosteroids should be added 24-48 hours after initiating antiviral therapy, typically oral prednisone at 1-2 mg/kg/day for 1-2 weeks with a gradual taper.
- Intravitreal foscarnet (2.4mg/0.1mL) or ganciclovir (2mg/0.1mL) injections may be used as adjunctive therapy, especially in cases with poor response to systemic treatment.
- Prophylactic laser photocoagulation should be considered to prevent retinal detachment, which occurs in up to 75% of cases.
- Early vitrectomy with silicone oil tamponade is recommended if retinal detachment occurs. It's worth noting that the provided evidence does not directly address the treatment of acute retinal necrosis, but rather discusses the treatment of varicella zoster virus conjunctivitis 1. However, based on general medical knowledge and the example provided, the above treatment protocol is recommended to minimize morbidity, mortality, and improve quality of life for patients with ARN. In cases where the patient is immunocompromised, more aggressive treatment may be necessary, and caution should be advised in patients with impaired renal clearance 1.
From the Research
Treatment Protocol for Acute Retinal Necrosis
The treatment protocol for acute retinal necrosis (ARN) typically involves antiviral medications, which can be administered orally, intravenously, or intravitreally. The choice of treatment approach depends on the severity of the disease and the patient's overall health.
Antiviral Medications
- Oral antiviral medications such as valacyclovir and famciclovir have been shown to be effective in treating ARN, with complete resolution of retinitis and improvement in visual acuity observed in some studies 2, 3.
- Intravenous antiviral medications, such as acyclovir, are also commonly used to treat ARN, especially in severe cases.
- Intravitreal antiviral injections, such as foscarnet, may be used in combination with systemic antiviral medications to treat ARN 2.
Treatment Outcomes
- A systematic review and meta-analysis of antiviral treatment for ARN found that the overall pooled estimated proportions of visual acuity improvement, recurrence, and retinal detachment were 37%, 14%, and 43%, respectively 4.
- Another study found that patients treated with systemic and intravitreal antivirals showed a trend towards better visual outcomes than those treated with systemic antivirals alone, although this analysis was not statistically significant 4.
Complications and Management
- Complications of ARN include retinal detachment, recurrence of the disease, and bulbar hypotony 5.
- Vitrectomy may be performed in some cases to repair retinal detachment, although the success of this procedure is difficult to evaluate 5.
- Early treatment with an appropriate approach is essential to avoid loss of vision, and prompt diagnosis and treatment are paramount to prevent further vision loss 6, 5.