Treatment Strategies for Neuroretinitis: Current Options and Emerging Therapies

by | CIRS, Functional & Integrative Medicine, Lyme Disease & Atypical Infections

https://link.springer.com/article/10.1007%2Fs11940-019-0579-9

Comment; So many options with treatment–there should not be a “cookbook” approach; an individualized approach on a “per patient” basis is needed. Steroids may be useful with severe vision loss due to excessive inflammation.

  • Aaron M. Fairbanks
  • Matthew R. Starr
  • John J. Chen
  • M. Tariq Bhatti
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          Neurologic Ophthalmology and Otology (R Shin and D Gold, Section Editors)First Online: 05 July 2019

          Part of the following topical collections:

          1. Topical Collection on Neurologic Ophthalmology and Otology

          Abstract

          Purpose of review

          To explore and critically appraise the published data on the current and emerging treatment modalities for neuroretinitis.

          Recent findings

          The optimum treatment strategy for neuroretinitis due to Bartonella henselae in immunocompetent individuals is not clear and a matter of debate. The role of systemic corticosteroids in infectious neuroretinitis and the optimum immunosuppressive regimen for use in recurrent idiopathic neuroretinitis also remains ill defined.

          Summary

          There is no class 1 evidence to support a specific treatment strategy for neuroretinitis. For uncomplicated B. henselae–associated neuroretinitis in immunocompetent patients, initiation of antibiotic and corticosteroid therapy remains controversial. In patients with severe vision loss and/or moderate to severe systemic symptoms, a 4- to 6-week regimen of doxycycline or azithromycin with rifampin may provide some benefit. The routine use of systemic corticosteroids in infectious neuroretinitis is not recommended. Targeted antimicrobial agents should be instituted in cases of neuroretinitis due to specific infectious etiologies (e.g., syphilis, Lyme disease, tuberculosis). Azathioprine may be beneficial in cases of recurrent idiopathic neuroretinitis. There is a need for collaborative, multicenter prospective studies to provide definitive guidelines regarding the use of antibiotics and corticosteroids and to evaluate future therapies in infectious and recurrent idiopathic neuroretinitis.

          Dr. Raymond Oenbrink
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