Oral valacyclovir, IV acyclovir appear comparable for treating acute retinal necrosis

This retrospective single-center study found that patients with acute retinal necrosis who were treated with oral valacyclovir had similar visual acuity outcomes as those treated with intravenous acyclovir. 

Study design

The single-center review includes patients seen over a 25-year period.  All patients had a clinical diagnosis of acute retinal necrosis and were treated with oral valacyclovir or intravenous acyclovir. A total of 62 patients (68 eyes) were included in the study. 

Outcomes

There were no significant differences in visual acuity outcomes between the 2 groups. Approximately half the patients in each group had severe vision loss.

Choice of drug did not appear to affect the probability of maintaining good vision or of developing a retinal detachment. In this series, barrier laser and administration of intravitreal antiviral therapy did not appear to affect outcome.

Limitations

There is an inherent selection bias between the treatment groups. Patients who had more severe disease may have been preferentially given one treatment over the other. Also, it is difficult to standardize the extent of retinal damage so there may have been imbalance between the two groups.

Clinical significance

Acute retinal necrosis often has a guarded visual prognosis regardless of the type of therapy.

Barrier laser treatment did not appear to affect visual acuity outcomes or the rate of retinal detachment. There did not appear to be an advantage to adjunctive intravitreal antiviral injection of either foscarnet or ganciclovir in reducing the retinal detachment rate. However, while only 1 of every 3 patients in the intravenous acyclovir group received adjunctive intravitreal injections, two-thirds of eyes in the oral valacyclovir group received intravitreal foscarnet injections.