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Case Reports
. 2010 Oct;150(4):511-8.
doi: 10.1016/j.ajo.2010.05.024. Epub 2010 Aug 5.

Patients with an acute zonal occult outer retinopathy-like illness rapidly improve with valacyclovir treatment

Vinit B Mahajan  1 , Edwin M Stone
Affiliations
Case Reports

Patients with an acute zonal occult outer retinopathy-like illness rapidly improve with valacyclovir treatment

Vinit B Mahajan et al. Am J Ophthalmol. 2010 Oct.

Abstract

Purpose: To describe 3 cases of an acute zonal occult outer retinopathy-like illness responsive to valacyclovir hydrochloride.

Design: Retrospective, interventional case series.

Methods: Three patients were treated with valacyclovir and monitored by clinical examination, Goldmann visual field testing, and electroretinography.

Results: Patients with an acute zonal occult outer retinopathy-like illness presented following progressive vision loss. This course was immediately reversed by treatment with oral valacyclovir, and visual acuity and visual field improved significantly at 1 week and 1 month. Patients remained stable without treatment during a follow-up period ranging from 1 to 3 years.

Conclusions: Some conditions with features of acute zonal occult outer retinopathy may be attributable to a subacute herpetic viral infection that is responsive to oral antiviral medication.

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Conflict of interest statement

B. Financial Disclosures: The authors have no commercial or financial interests.

Figures

Figure 1
Figure 1. Case-1. The subject showed clinical features of AZOOR that improved following valacyclovir treatment
A, Normal fundus image of the right eye. B, Normal fundus image of the left eye. C, Goldmann visual field of the left eye shows new field constriction and scotoma. D, Goldmann visual field of the right eye shows constriction of all isopters. E, F, Goldmann visual fields showed improvement after 1-week following valacyclovir treatment. G, H, Goldmann visual field of the left eye showed normalization after 1-month of valacyclovir treatment and significant expansion in the right eye. I, ERG shows diminished b-wave in the right eye compared to the left eye. J, A photograph of the left peripheral fundus shows a subtle patchy retinal pigment epithelial atrophy in the area corresponding to visual field loss.
Figure 2
Figure 2. Case 2. Valacyclovir treatment reversed visual changes in the second eye of an AZOOR subject
A, Right fundus image shows old pigmentary changes, waxy disc pallor, and vascular attenuation. B, Normal fundus appearance in the newly symptomatic left eye. C, Goldmann visual field of the left eye shows new central scotomas. D, Goldmann visual field of the right eye demonstrates a stable, severe peripheral constriction and ring scotoma present 30 months prior to the development of symptoms in the left eye. E, Goldmann visual field of the left eye showed normalization after 1- week treatment with valacyclovir. F, Goldmann visual fields of the left eye also showed mild expansion. G, The central scotomas in the left eye disappeared completely after 1-month of valacyclovir. H, There was retinal thinning with loss of the photoreceptor layer in the right eye (upper panel). This was not observed with treatment of the newly symptomatic left eye (lower panel).
Figure 3
Figure 3. Case-3. New onset visual features of AZOOR rapidly improved after treatment with valacyclovir
A, Normal fundus image of the symptomatic right eye. B, Normal fundus image of the asymptomatic left eye. C, Multifocal ERG shows abnormal, depressed waveforms in the central macula of the right eye (left panel) compared to the left eye (right panel). D, Normal Goldmann visual field of the left eye. E, Goldmann and Humphrey visual field (inset) of the right eye shows central scotomas and an enlarged blind spot. F, There is increased reflectivity in the outer nuclear layer (left arrow) corresponding to the area of visual field loss. G, Humphrey visual field of the left eye shows normalization after valacyclovir.
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