Comparing Treatment of Acute Retinal Necrosis With Either Oral Valacyclovir or Intravenous Acyclovir
Comparing Treatment of Acute Retinal Necrosis With Either Oral Valacyclovir or Intravenous Acyclovir
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DOI：
10.1016/j.ajo.2018.02.001
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发表时间：
2018-04-01
影响因子：
4.2
通讯作者：
Tomkins-Netzer, Oren
中科院分区：
文献类型：
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作者：
Baltinas, Julijana;Lightman, Sue;Tomkins-Netzer, Oren
目的：比较静脉注射阿昔洛韦和口服万乃洛韦治疗急性视网膜坏死(ARN)患者的视力结果。设计：回顾性、对照、干预病例系列。方法：通过医院的电子数据库对1992年至2016年在英国Moorfield眼科医院收治的62例(68只眼)ARN患者进行分析。排除标准包括患者记录不足或随访(<；150天)。56例为单侧ARN，6例为双侧ARN。对确诊时接受静脉注射阿昔洛韦的患者(n=33)和口服万乃洛韦的患者(n=29)的结果进行比较，结果包括最佳矫正视力、视网膜脱离、严重视力丧失和其他并发症。结果：在5年的随访数据中，静脉治疗和口服治疗的最佳矫正视力的变化没有显著差异(P=0.16)。两组的严重视力损失率(分别为46%和59%，P=.18)和保持良好视力的眼(分别为28%和31%，P=.80)均无差异。视网膜脱离的发生率为63%，不同治疗组之间差异无统计学意义(分别为62%和66%，P=.67)。阻挡激光和玻璃体内治疗对视网膜脱离发生率均无影响。结论：口服万乃洛韦治疗ARN临床疗效与静脉治疗相当。因此，口服万乃洛韦作为门诊治疗，无论是否玻璃体内注射磷甲酸钠，都可以被认为是静脉治疗所需住院治疗的可接受替代方案。(C)2018 Elsevier Inc.保留所有权利。
PURPOSE: To compare the visual outcomes of patients with acute retinal necrosis (ARN) treated initially with intravenous acyclovir vs oral valacyclovir therapy.DESIGN: Retrospective, comparative, interventional case series.METHODS: Sixty-two patients (68 eyes) with ARN, treated at Moorfields Eye Hospital (United Kingdom) between 1992 and 2016, were identified through the hospital's electronic database. Exclusion criteria included insufficient patient records or follow-up (< 150 days). Fifty-six patients had unilateral ARN, while 6 had bilateral ARN. Patients who received intravenous acyclovir on diagnosis (n = 33) were compared with patients treated with oral valacyclovir (n = 29) across outcomes including best-corrected visual acuity, retinal detachment, severe vision loss, and other complications. The impact of adjunctive intravitreal antiviral and prophylactic barrier laser treatment was also assessed.RESULTS: Change in best-corrected visual acuity was not significantly different for eyes treated initially with intravenous therapy vs oral therapy over 5 years of follow-up data (P =.16). There was no difference in the rates of severe vision loss between the 2 groups (46% and 59%, respectively, P =.18), or of those eyes retaining good vision (28% vs 31%, respectively, P =.80). Retinal detachment occurred in 63% of cases and did not differ across treatment groups (62% vs 66%, respectively, P =.67). Barrier laser and intravitreal therapy had no effect on retinal detachment rate in either group.CONCLUSION: Oral valacyclovir is clinically equivalent to intravenous therapy in the management of ARN. Oral valacyclovir as an outpatient therapy with or without intravitreal foscarnet can therefore be considered as an acceptable alternative to inpatient therapy required for intravenous treatment. (C) 2018 Elsevier Inc. All rights reserved.