MANAGEMENT OF VARICELLA-ZOSTER VIRUS RETINITIS IN AIDS

Aims/background-Varicella tester virus retinitis (VZVR) in patients wi th AIDS, also called progressive outer retinal necrosis (PORN), is a n ecrotising viral retinitis which has resulted in blindness in most pat ients. The purposes of this study were to investigate the clinical cou rse and visual outcome, and to determine if the choice of a systemic a ntiviral therapy affected the final visual outcome in patients with VZ VR and AIDS. Methods-A review of the clinical records of 20 patients w ith VZVR from six centres was performed. Analysis of the clinical char acteristics at presentation was performed. Kruskall-Wallis non-paramet ric one way analysis of variance (KWAOV) of the final visual acuities of patients treated with acyclovir, ganciclovir, foscarnet, or a combi nation of foscarnet and ganciclovir was carried out. Results-Median fo llow up was 6 months (range 1.3-26 months). On presentation, 14 of 20 patients (70%) had bilateral disease, and 75% (15 of 20 patients) had previous or concurrent extraocular manifestations of VZV infection. Me dian initial and final visual acuities were 20/40 and hand movements, respectively. Of 39 eyes involved, 19 eyes (49%) were no light percept ion at last follow up; 27 eyes (69%) developed rhegmatogenous retinal detachments. Patients treated with combination ganciclovir and foscarn et therapy or ganciclovir alone had significantly better final visual acuity than those treated with either acyclovir or foscarnet (KWAOV: p = 0.0051). Conclusions-This study represents the second largest serie s, the longest follow up, and the first analysis of visual outcomes ba sed on medical therapy for AIDS patients with VZVR. Aggressive medical treatment with appropriate systemic antivirals may improve long term visual outcome in patients with VZVR. Acyclovir appears to be relative ly ineffective in treating this disease.