Document 0079
 DOCN  M9480079
 TI    [Bilateral acute retinal artery necrosis--healing of the second affected
       eye]
 DT    9410
 AU    Kalman A; Vogt M; Bernasconi E; Gloor B; Augenklinik,
       Universitatsspitales Zurich.
 SO    Klin Monatsbl Augenheilkd. 1994 Apr;204(4):235-40. Unique Identifier :
       AIDSLINE MED/94293569
 AB    BACKGROUND: The acute retinal necrosis syndrome (ARN) is caused by the
       Varicella zoster virus or the Herpes simplex virus. However the dosage
       and duration of the antiviral therapy for prevention of an infection in
       the second eye or treatment of an infection on an affected fellow eye is
       still not known. We discuss the timing of a possible steroid treatment
       and demonstrate in a case report how an acute retinal necrosis syndrome
       in a fellow eye was successfully treated. PATIENT: First eye: A
       27-year-old not immunocompromised patient (HIV-negative) showed 2 months
       after a febrile state an acute iritis in the right eye. 14 days later an
       acute retinal necrosis syndrome was observed. The patient received
       Acyclovir 3 x 750 mg i.v. for 6 days, and afterwards 5 x 200 mg orally
       for 5 days. The patient developed an inoperable retinal detachment
       despite therapy. Second eye: Eight days later the fellow eye developed a
       localized retinal necrosis. Varicella zoster DNA was found in the
       aqueous humor using the polymerase chain reaction (PCR). The antiviral
       therapy with Acyclovir was increased from 1.1 g q 12 h (2 x 15 mg/kg/d)
       to 1.0 g q 8 h (3 x 12.5 mg/kg/d). After 4 weeks the i.v. therapy was
       followed by an oral therapy of 5 x 800 mg for 12 weeks. This dosage was
       reduced to 5 x 400 mg for another 12 weeks. The oral therapy with
       corticosteroids started on the 11th day with 100 mg Prednisone, in
       slowly reducing dosage during 18 weeks. The fellow eye recovered fully
       with a visual acuity of 20/20 after 6 months. CONCLUSION: The disease
       started in the fellow eye with an acute iritis and a secondary glaucoma.
       These symptoms can be a characteristic prodroma of an acute retinal
       necrosis syndrome caused by a varicella zoster- or Herpes simplex virus
       infection, which was not recognized first. Whether a long-term therapy
       (as described above) is necessary or not is unclear on the basis of a
       single case report, but we currently recommend the high-dose treatment
       regimen until further data emerge.
 DE    Acyclovir/*ADMINISTRATION & DOSAGE  Administration, Oral  Adult  Case
       Report  Dose-Response Relationship, Drug  Drug Administration Schedule
       English Abstract  Fluorescein Angiography  Follow-Up Studies  Herpes
       Zoster Ophthalmicus/DIAGNOSIS/*DRUG THERAPY  Herpesvirus 3,
       Human/ISOLATION & PURIF  Human  Infusions, Intravenous  Intraocular
       Pressure/DRUG EFFECTS  Male  Recurrence  Retinal Necrosis Syndrome,
       Acute/DIAGNOSIS/*DRUG THERAPY  Visual Acuity/DRUG EFFECTS  JOURNAL
       ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).