Harvard Medical School, Boston, Massachusetts, USA.
Ophthalmology. 2010 Apr;117(4):818-24. doi: 10.1016/j.ophtha.2009.09.001. Epub 2010 Jan 15.
To compare outcomes from patients with acute retinal necrosis (ARN) treated in the acyclovir-only era with those treated in the era of newer antiviral therapies, identify variables affecting outcomes in ARN, and evaluate strategies for fellow eye prophylaxis.
Multicenter, nonrandomized, retrospective, interventional series.
A cohort of 58 patients diagnosed with ARN by a retina specialist at 1 of 4 referral centers between 1981 and 2008. The cohort was divided into 2 subgroups: patients treated during the acyclovir-only era (n = 36) and patients treated during the current era of newer antiviral medications (n = 22).
Intravenous, oral, or intravitreal antiviral medications, including acyclovir, valacyclovir, famciclovir, valganciclovir, ganciclovir, and foscarnet; prophylactic laser retinopexy; aspirin; oral steroids.
Visual acuity, retinal detachment, and fellow eye involvement.
A wide range and combination of antiviral agents are currently used for initial and long-term treatment of ARN. Outcomes from the newer antivirals era were similar to those achieved during the acyclovir-only era. In both groups, the incidence of 20/200 or worse visual acuity was 24% per person-year (P = 0.91). The prevalence of retinal detachment was approximately 50% in each group (P = 0.59). No variables, including prophylactic laser retinopexy, were associated with risk of retinal detachment. Two patients (3.4%) developed ARN in the initially unaffected eye.
Current treatment trends vary widely, including single agents or combinations of oral, intravenous, and intravitreal agents. Differing strategies did not affect outcomes. The final visual acuity in ARN was generally poor. Retinal detachment was common and could neither be predicted nor prevented. Development of ARN in the unaffected fellow eye occurred rarely. Long-term oral antiviral treatment strategies varied with unclear relative efficacy.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
比较急性视网膜坏死（ARN）患者在阿昔洛韦时代和新型抗病毒治疗时代的治疗效果，确定影响ARN 结局的变量，并评估对侧眼预防策略。
多中心、非随机、回顾性、干预性系列研究。
1981 年至 2008 年间，4 家转诊中心的一位视网膜专家诊断为 ARN 的 58 名患者组成的队列。该队列分为 2 个亚组：阿昔洛韦时代治疗的患者（n = 36）和新型抗病毒药物治疗时代的患者（n = 22）。
包括阿昔洛韦、伐昔洛韦、泛昔洛韦、缬更昔洛韦、更昔洛韦和膦甲酸在内的静脉、口服或玻璃体内抗病毒药物；预防性激光视网膜光凝术；阿司匹林；口服类固醇。
视力、视网膜脱离和对侧眼受累。
目前，广泛使用多种抗病毒药物联合治疗 ARN 的初始和长期治疗。新型抗病毒药物治疗时代的结局与阿昔洛韦时代相似。在两组中，20/200 或更差视力的发生率为每人每年 24%（P = 0.91）。每组的视网膜脱离发生率约为 50%（P = 0.59）。包括预防性激光视网膜光凝术在内的任何变量均与视网膜脱离风险无关。有 2 名患者（3.4%）最初未受累的眼睛中发生 ARN。
目前的治疗趋势差异很大，包括单药或口服、静脉和玻璃体内药物联合治疗。不同的策略并未影响结局。ARN 的最终视力通常较差。视网膜脱离很常见，无法预测或预防。未受累对侧眼发生 ARN 很少见。长期口服抗病毒治疗策略因相对疗效不明确而异。
参考文献后可能会有专有或商业披露。
