Brivudin als Alternative Systemische Therapie zu Aciclovir und Ganciclovir bei Akutem Retinalen Nekrosesyndrom durch Varizella-Zoster-Virus

Translated title of the contribution: Brivudine as an Alternative Systemic Therapy to Aciclovir and Ganciclovir in Acute Retinal Necrosis Syndrome Due to Varicella-Zoster Virus

Oliver Vij, Norbert Bornfeld, Michael Roggendorf, Melanie Fiedler, Harald Schilling

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background: Two cases of acute retinal necrosis (ARN-) syndrome caused by an infection with varicella zoster virus (VZV) are demonstrated. VZV-DNA was detected in vitreous biopsies by polymerase-chain-reaction (PCR). The course of retinal necrosis was decisively improved by changing antiviral therapy from aciclovir and/or ganciclovir to brivudine. Material and methods: Patient 1: 51 years, male, initial visual acuity 20/40; patient 2: 17 years, female, initial visual acuity 20/30. Both patients were immunocompetent and presented with an unilateral acute retinal necrosis syndrome with peripheral chorioretinitis, retinal vasculitis, vitreous inflammation and optic disc swelling, which resulted in progressive visual loss in a few days. Results: In both patients VZV-DNA was detected in vitreous biopsies with PCR. A regression of intraocular inflammation and necrotic retinal foci was only observed after changing the initial systemic therapy from aciclovir (Zovirax® intravenously 1500 mg/day) and/or ganciclovir (Cymeven® intravenously 250 mg/day) to brivudine (Zostex® per os 500 mg/day). Vitreoretinal surgery was necessary in both patients because of rhegmatogenous retinal detachment. Visual acuity stabilised in patient 1 to 20/200 and in patient 2 to 20/25 during a follow-up of 16 or 32 months, respectively. Conclusion: Brivudine represents an alternative therapy, if standard treatment with aciclovir and/or ganciclovir failed in cases of ARN-syndrome due to presumed drug-resistant varicella zoster virus-subtypes. Complete remission and preservation of a satisfactory function can be achieved.

Translated title of the contributionBrivudine as an Alternative Systemic Therapy to Aciclovir and Ganciclovir in Acute Retinal Necrosis Syndrome Due to Varicella-Zoster Virus
Original languageGerman
Pages (from-to)710-715
Number of pages6
JournalKlinische Monatsblatter fur Augenheilkunde
Volume220
Issue number10
DOIs
StatePublished - Oct 2003
Externally publishedYes

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