Ciulla T A, Rutledge B K, Morley M G, Duker J S
Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, USA.
Ophthalmic Surg Lasers. 1998 Mar;29(3):198-206.
To assess a two-drug combination of antiviral therapy for the progressive outer retinal necrosis syndrome (PORN), given the current poor outcome with acyclovir alone.
A retrospective review was performed on six consecutive patients who were diagnosed with PORN and were treated with various combinations of intravenous or oral plus intravenous antiviral therapy. The relative efficacies of these modalities were compared.
Six eyes of six patients showed active retinitis at the time of presentation. Three patients had unilateral retinitis, and the remaining patients had necrotic, 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 were employed. During the combination therapy, all six eyes showed resolution of the retinitis, manifested by complete fading of the original retinal lesions and an absence of new lesion formation. At the final follow-up, the areas of prior active retinitis had resolved and remained quiescent. A mild recurrence developed in one eye when ganciclovir and 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 for the duration of follow-up (38 and 27 weeks, respectively). One patient maintained a visual acuity of 20/40 for 14 weeks. The remaining three patients had macula-off retinal detachments despite resolution of active retinitis. In addition, for the duration of follow-up, one of the three patients with unilateral disease had retinitis in the uninvolved eye; all three uninvolved fellow eyes maintained a visual acuity of 20/20. One patient had progressive optic atrophy.
Prolonged combination antiviral therapy for PORN may successfully arrest the progression of retinitis, maintain remission, and prevent involvement of the fellow eye. Furthermore, if aggressive therapy is begun early, good vision may be preserved.
鉴于目前单独使用阿昔洛韦治疗进展性外层视网膜坏死综合征（PORN）效果不佳，评估两种药物联合抗病毒治疗方案。
对连续6例诊断为PORN并接受静脉或口服加静脉抗病毒治疗不同组合的患者进行回顾性研究。比较这些治疗方式的相对疗效。
6例患者的6只眼在就诊时均显示有活动性视网膜炎。3例患者为单侧视网膜炎，其余患者的对侧眼患有坏死性终末期疾病。所有患者均接受联合治疗，包括更昔洛韦与阿昔洛韦联合（3例患者）、膦甲酸钠与更昔洛韦联合（2例患者）或膦甲酸钠与阿昔洛韦联合（1例患者）。采用标准诱导剂量。在联合治疗期间，所有6只眼的视网膜炎均消退，表现为原视网膜病变完全消退且无新病变形成。在最后一次随访时，先前活动性视网膜炎的区域已消退并保持静止。当更昔洛韦和膦甲酸钠均减至每日单次剂量时，1只眼出现轻度复发。再次诱导（每日两次）给药后，复发迅速缓解。2例患者在随访期间（分别为38周和27周）患眼视力维持在20/50或更好。1例患者视力在14周内维持在20/40。尽管活动性视网膜炎已消退，但其余3例患者发生了黄斑脱离视网膜脱离。此外，在随访期间，3例单侧疾病患者中有1例的未受累眼发生视网膜炎；所有3只未受累的对侧眼视力维持在20/20。1例患者出现进行性视神经萎缩。
PORN的长期联合抗病毒治疗可能成功阻止视网膜炎进展、维持缓解并预防对侧眼受累。此外，如果早期开始积极治疗，可保留良好视力。
