THE PROGRESSIVE OUTER RETINAL NECROSIS SYNDROME - SUCCESSFUL TREATMENT WITH COMBINATION ANTIVIRAL THERAPY

BACKGROUND AND OBJECTIVE: To assess a two-drug combination of antivira l therapy for the progressive outer retinal necrosis syndrome (PORN), given the current poor outcome with acyclovir alone. PATIENTS AND METH ODS: A retrospective review was performed on six consecutive patients who were diagnosed with PORN and were treated with various combination s of intravenous or oral plus intravenous antiviral therapy. The relat ive efficacies of these modalities were compared. RESULTS: Six eyes of six patients showed active retinitis at the time of presentation, Thr ee patients had unilateral retinitis, and the remaining patients had n ecrotic, end-stage disease in their fellow eye. All the patients were treated with combination therapy, consisting of either ganciclovir and acyclovir (three patients), foscarnet and ganciclovir (two patients), or foscarnet and acyclovir (one patient). Standard induction doses we re employed, During the combination therapy, all six eyes showed resol ution of the retinitis, manifested by complete fading of the original retinal lesions and an absence of new lesion formation. At the final f ollow-up, the areas of prior active retinitis had resolved and remaine d quiescent. A mild recurrence developed in one eye when ganciclovir a nd foscarnet were both tapered to a single daily dose. This recurrence promptly resolved with reinduction (twice daily) dosing. Two patients maintained a visual acuity of 20/50 or better in their involved eye f or the duration of follow-up (38 and 27 weeks, respectively). One pati ent maintained a visual acuity of 20/40 for 14 weeks. The remaining th ree patients had macula-off retinal detachments despite resolution of active retinitis. In addition, for the duration of follow-up, one of t he three patients with unilateral disease had retinitis in the uninvol ved eye; all three uninvolved fellow eyes maintained a visual acuity o f 20/20. One patient had progressive optic atrophy. CONCLUSIONS: Prolo nged combination antiviral therapy for PORN may successfully arrest th e progression of retinitis, maintain remission, and prevent involvemen t of the fellow eye, Furthermore, if aggressive therapy is begun early , good vision may be preserved.