Vitreous penetration of orally administered famciclovir.

PURPOSE: To determine the vitreous penetration of penciclovir (Denavir; GlaxoSmithKline, Philadelphia, Pennsylvania, USA) after oral administration of the prodrug famciclovir (Famvir; Novartis Pharmaceuticals Corp, East Hanover, New Jersey, USA). DESIGN: Prospective interventional case series. METHODS: Ten patients undergoing elective pars plana vitrectomy at a single institution were enrolled to take 3 oral doses of famciclovir 500 mg the day preceding surgery and a fourth dose on the morning of surgery. Blood and undiluted vitreous samples were acquired from each patient during surgery. High-performance liquid chromatography was used to determine the concentration of penciclovir in each sample. Exclusion criteria included prior vitrectomy, compromised blood-retina barrier, renal or hepatic disease, human immunodeficiency virus infection, bone marrow or renal transplantation, pregnancy or breastfeeding, history of adverse reaction or allergy to famciclovir or penciclovir, and antiviral, probenecid, or cimetidine use within 1 month of surgery. RESULTS: Ten eyes of 10 patients ranging in age from 26 to 82 were included. All patients had normal renal and hepatic function as determined by history and laboratory values. Mean serum penciclovir concentration +/- standard deviation was 4.45 +/- 1.31 microg/ml (range, 2.51 to 6.34 microg/ml). Mean vitreous penciclovir concentration was 1.21 +/- 0.38 microg/ml (range, 0.39 to 1.88 microg/ml). Mean vitreous-to-serum concentration ratio of penciclovir was 0.28 +/- 0.09 (range, 0.16 to 0.41). CONCLUSIONS: Oral administration of famciclovir results in vitreous concentrations of penciclovir within the inhibitory ranges for herpes simplex 1, herpes simplex 2, and varicella zoster virus. Oral famciclovir may be a reasonable alternative to intravenous acyclovir (Zovirax; GlaxoSmithKline) in the treatment of acute retinal necrosis, especially in cases of acyclovir resistance or patient inability to tolerate prolonged intravenous treatment.

Vitreous penetration of orally administered valacyclovir.

PURPOSE: To investigate the vitreous penetration of acyclovir, the active metabolite of valacyclovir, after oral administration of valacyclovir. DESIGN: Prospective, interventional case series. METHODS: Ten patients scheduled for elective pars plana vitrectomy at a single academic institution were given three oral doses of valacyclovir 1000 mg eight hours apart the day before surgery, with a fourth dose on the morning of surgery. Blood and undiluted vitreous samples were obtained during surgery and subsequently were analyzed with high-performance liquid chromatography to determine the concentrations of acyclovir present. RESULTS: Ten eyes of 10 subjects ranging in age from 46 to 83 years were included. All patients had normal renal and hepatic function as confirmed by metabolic panels obtained before surgery. Mean serum acyclovir concentration +/- standard deviation was 4.41 +/- 0.88 microg/ml (range, 3.18 to 5.92 microg/ml), mean vitreous acyclovir concentration was 1.03 +/- 0.23 microg/ml (range, 0.67 to 1.33 microg/ml), and mean vitreous-to-serum concentration ratio of acyclovir was 0.24 +/- 0.06 (range, 0.16 to 0.34). CONCLUSIONS: Orally administered valacyclovir results in substantial vitreous penetration of acyclovir. The vitreous concentrations achieved in noninflamed eyes are within the reported inhibitory ranges for most strains of herpes simplex 1, herpes simplex 2, and varicella zoster virus. This suggests that orally administered valacyclovir may be an alternative to intravenous acyclovir in the treatment of acute retinal necrosis.

Subretinal Candida albicans abscesses responsive to oral voriconazole.

PURPOSE: To report findings in a patient with bilateral Candida albicans subretinal abscesses responsive to oral voriconazole. METHODS: Retrospective, case report. RESULTS: A 62-year-old woman presented with bilateral C albicans subretinal abscesses secondary to chronic immunosuppression. The abscesses responded to oral voriconazole and resolved completely within 4 months of initial presentation. CONCLUSIONS: This case illustrates that oral voriconazole may be effective in the treatment of large subretinal abscesses in an immunocompromised patient. Additionally, this report suggests that a subretinal aspirate may have greater diagnostic sensitivity than a vitreous specimen in eyes with infectious subretinal abscesses.

The behavior of surgically repaired idiopathic macular holes in the setting of subsequent cystoid macular edema.

PURPOSE: To report findings for eyes with surgically repaired idiopathic macular hole that subsequently developed cystoid macular edema (CME). METHODS: This study was a retrospective chart review of six eyes of six consecutive patients evaluated between January 1997 and October 2000 who had successful macular hole repair and subsequently developed CME. Patient demographic data, cause and time course of CME, treatment, and outcomes, including macular hole reopening, were recorded. RESULTS: CME developed after cataract extraction in five eyes and after macular hole surgery alone in one eye. Average time from macular hole surgery to diagnosis of CME was 11.2 months (range, 2.5-23.0 months). Average duration of CME was 5.5 months (range, 1.5-17.0 months). Five (83%) of 6 eyes had sustained closure of the macular hole throughout a mean follow-up period of 31.8 months (range, 9.5-62.0 months). Patients were treated with topical antiinflammatory therapy, and all had resolution of CME. CONCLUSIONS: CME developing in eyes with surgically repaired idiopathic macular holes responds well to conventional topical antiinflammatory therapy and is not associated with a high incidence of macular hole reopening. These results suggest that in most eyes the reparative mechanisms involved in macular hole closure confer sufficient strength to withstand the tensile forces associated with CME.

Delayed posttraumatic Propionibacterium acnes endophthalmitis in a child.

A 7-year-old boy presented with granulomatous anterior uveitis after an unrecognized penetrating injury in the same eye 2 months previously. The uveitis was unresponsive to topical corticosteroid therapy, lensectomy with anterior vitrectomy, and administration of intraocular and subconjunctival injections of vancomycin. Pars plana vitrectomy, capsulectomy, and injection of intravitreal vancomycin were eventually performed, leading to complete resolution of the intraocular inflammation. Culture and histopathologic examination of a capsular specimen confirmed sequestered Propionibacterium acnes infection. This case demonstrates that P. acnes may cause delayed endophthalmitis following penetrating trauma and may persist within capsular remnants in the aphakic eye.

Complications of bioabsorbable orbital implants and fixation plates.

After orbital floor and trimalar fracture repair with the use of a bioabsorbable maxillofacial implant, a patient had eyelid retraction with a thickened, immobile eyelid. We observed a dense, fibrous scar and encapsulation at the implantation site.