How is acute retinal necrosis and progressive outer retinal necrosis in HIV infection treated?

Updated: Jun 12, 2019
  • Author: Robert A Copeland, Jr, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Answer

Answer

Start acyclovir 5-10 mg/kg/day IV in 3 divided doses for 1 week, then change to oral acyclovir 800 mg 5 times daily for the following 1-2 months. Monitor blood urea nitrogen and creatine levels because of the nephrotoxic effect of acyclovir.

Start a slow tapering dosage of prednisone, 60-100 mg orally daily 24 hours after starting acyclovir, and continue for about 1-2 months. Be sure to obtain a chest radiograph and PPD before starting the oral steroid. Add ranitidine 150 mg orally twice daily for steroid-induced gastritis.

Use a topical steroid, such as prednisolone acetate 1%, instilled every 2-6 hours, and a cycloplegic agent, such as homatropine 5% instilled 2-3 times daily.

In fulminant cases, IV ganciclovir and/or cidofovir, with intravitreal ganciclovir and/or foscarnet, may be considered. Ganciclovir, foscarnet, and cidofovir are given in the same dosages as for CMV retinitis (see above).

Use of retinal laser photocoagulation to surround the necrotic lesion is controversial.

For retinal detachment, vitrectomy, membranectomy, endolaser, and silicone oil infusion usually is required.


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