Table 1 Clinical characteristics and visual outcomes in patients with herpetic retinal necrosis associated with natalizumab
From: Bilateral acute retinal necrosis in a patient with multiple sclerosis on natalizumab
Publication | Age (years) | Sex | Laterality | |
Kobeleva et al. | 49 | M | Bilateral | |
Saraiva | 51 | M | Unilateral (right eye) | |
Van Tassel et al. | 54 | F | Unilateral (left eye) | |
Current study | 34 | F | Bilateral | |
Publication | Initial VA | Treatment/clinical course | Length of follow-up | VA at the last follow-up |
Kobeleva et al. | Not reported | CNS vasculitis and necrotizing retinitis treated with combination of IV acyclovir, high-dose IV methylprednisone and 5 cycles of plasma exchange therapy to accelerate natalizumab clearance. | 4 months | “Almost completely blind.” |
Cyclophosphamide was given after steroids and plasma exchange. | ||||
Saraiva | 20/30 OD | Natalizumab was discontinued. Oral valacyclovir 1 g TID for 3 months. Oral prednisone initiated 4 days after starting valacyclovir. Propophylatic laser retinal photocoagulation performed 14 days after initiation of antiviral therapy. One month after discontinuing antiviral therapy, the patient developed immune reconstitution inflammatory syndrome. Systemic steroids resolved inflammation. | 5 months | 20/30 OD |
Van Tassel et al. | 20/125 OS | Natalizumab was discontinued. IV and intravitreal antivirals were administered. Complicated by late retinal detachment. | 2 months | 20/125 OS |
Current study | 20/25 OD, 20/50 OS | Natalizumab was discontinued. IV and intravitreal antivirals were administered. Complicated by late retinal detachment and optic atrophy. | 11 months | 20/30 OD, HM OS |