Cidofovir is potential treatment for HSV acute retinal necrosis

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The outcomes of 18 patients with polymerase chain reaction-positive acute retinal necrosis were compared by viral type including varicella zoster virus in 8 eyes, HSV-1 in 2 eyes, and HSV-2 in 12 eyes. Best-corrected visual acuity averaged 20/51, 20/25, and 20/814, respectively. Most eyes with HSV-2 (75%) experienced retinal detachment whereas only 25% of eyes with varicella zoster virus did.

Treatment with cidofovir for refractory retinitis was used in 1 eye with HSV-1 and 3 eyes with HSV-2.

“Acute retinal necrosis secondary to HSV-2 tended to have persistent active retinitis with a higher rate of retinal detachment despite similar treatment protocols, suggesting that in some cases combination intravenous acyclovir and adjuvant intravitreal foscarnet injections are not sufficient,” the authors concluded. “Despite the risk of renal toxicity, intravenous cidofovir may be a consideration in select patients.”

Botsford BW, Nguyen V, Eller AW. Acute retinal necrosis: Difference in outcome by viral type and options for antiviral therapy. Retina. 2021;41(7):1547-1552. doi: 10.1097/IAE.0000000000003058

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