Oral Valacyclovir Effectively Treating Acute Retinal Pigment Epithelitis in Cases Unresponsive to Oral Steroids Alone

PURPOSE: Acute Retinal Pigment Epithelitis (ARPE) with a protracted course and not responding to treatment with systemic steroids alone showed recovery after oral Valacyclovir. METHODS: Three patients diagnosed with ARPE were studied. They presented with decreased vision and Optical Coherence Tomography (OCT) showed disruption of the outer retinal layers. They were first treated with systemic steroids alone. When the disease persisted, we gave a course of oral Valacyclovir. RESULTS: All three patients after receiving oral Valacyclovir showed regeneration of the outer retinal layers with improvement in affected eye best corrected visual acuity (BCVA). In Case 1 BCVA improved from RE 5/60, LE 6/60 to BE 6/6 at final visit. Case 2 LE BCVA improved from 5/60 to 6/9 and Case 3 RE BCVA improved from 6/9 to 6/6. In Cases 1 and 2, there was complete recovery of the interdigitation zone (IZ) on OCT at final visit. In Case 3, there was only partial regeneration of IZ layer explaining LE BCVA 6/9 at final visit. CONCLUSION: It is challenging to determine to the etiology, pathophysiology, and treatment of ARPE due to its rare incidence. However, when the disease is not self-limiting and BCVA continues to worsen, we might consider using antiviral therapy as treatment.