3214 Association of herpetic encephalitis with acute retinal necrosis syndrome proved by the polymerase chain reaction

Purpose : To discuss the definition and to determine the most logical intervention in treating patients with clinically foscamet resistant cytomgalovirus retinitis. Patients : Two patients with foscarnet clinically resistant cytomegalovims retinitis were followed in our department since june 1994. In these 2 patients, foscarnet was the first antiviral drug theraw civen for the treamxnt of cvtomeaalovims retinitis. Rest&s-Foscamet clinically resi&nt r&&is progressed despite a 6 and 4 weeks of induction doses of foscarnet. Cvtomeealoviros viremia was positive. 7he use of intraveinous ganciciovir in-one case or combination therapy with ganciclovir and foscarnet in the other was effective in halting the progression of retinitis. Conclusions : Clinically foscarnet cytomegalovirus retinitis resistance is probably a manifestation of infection by cytomegaloviros that has squired drug resistance. It is likely that clinically resistant red&is will become more fxquent as patients with cytomegalovims retinitis and AIDS survive longer. An interesting question is wether the resistance to the antiviral drug therapy represents a local phenomenon within the retina or is a reflection of a systemically resistant strain with resistant viremia. Putpose To assess the efficacy of ocular surgery in viral retinitis-associated retinal &tachments in AIDS. Methods: Twenty-four eyes of 22 consecutive patients, presenting with cytomegalovirus retinitis (21 eyes), or Varicella-Zosterviros retinitis (3 eyes) were included. Retinal detachment was bilateral in 6 patients (25%). and involved the macula in 20 eyes (83%). Surgical procedure consisted in pars plana vitrectomy and silicone oil tampon& in 23 eyes (96%). Scleral buckling was petfortned in the first 10 eyes (42%). Results: Retina flattened postoperatively in all cases. Retinal detachment relapsed in one eye (4%). without involving the posterior pole. No proliferative vitreoretinopathy (PVR) was observed during follow-up. Visual acuity improved in 14 eyes (58%), decreased in 7 eyes (29%) and stabilized in 3 eyes (12%). The mean follow-up period was 10 weeks. Conclusions: Vitrectomy and silicone oil tamponade is successful m the surgical treatment of viral retinitis-associated retinal detachments in AIDS. Scleral buckling is not necessary because, in our experience, no PVR occurs after surgery. The alteration of visual functions is related to the extension of retinitis at the posterior pole, and the occurrence of optic neuritis. Visual outcome is better in cytomegalovirus retinitis than in VZV retinitis.