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3,4 The incidence of viral retinitis is equal between males and females, and estimated at 0.63 cases per million population per year with a large variation in age of presentation.5,6 Diagnosis is based on the American Uveitis Society clinical criteria, which includes focal well-demarcated areas of retinal necrosis located in the peripheral retina, rapid and circumferential progression of necrosis, evidence of occlusive vasculopathy, and prominent inflammatory reaction in the vitreous and anterior chamber.7 Etiology in immunocompetent people is varicella zoster virus (VZV) in 50%, herpes simplex virus (HSV) in 25%, Epstein�CBarr virus in 15%, and cytomegalovirus (CMV) in 1%. CMV is much more common in immunocompromised patients.8�C10 Polymerase chain-reaction (PCR) analysis of aqueous and vitreous samples is the gold standard for diagnosis (sensitivity 95%, specificity 97%),11�C13 and for monitoring disease course and response to therapy via viral load quantification.14�C16 Currently, oral FRAX597 medications, such as acyclovir (800 mg five times per day),17 valacyclovir (1 g ter in die [TID three times a day]),18 and famciclovir (500 mg TID)19 are recommended, and seem to have similar efficacy to the traditional intravenous acyclovir (1,500 mg/m2 body surface area) regimen.20 Oral agents like valacyclovir (Valtrex; GlaxoSmithKline PLC, London, UK) and famciclovir (Famvir; Novartis International AG, Basel, Switzerland) have superior bioavailability and central nervous system penetration compared to acyclovir, and seem to have utility in both the initial treatment and maintenance therapy of patients with viral retinitis.3 Rhegmatogenous retinal detachment (RRD) is common in viral retinitis, occurring in 20%�C75% of eyes, with resultant poor visual outcomes.21�C24 RRD usually occurs after the acute phase of infection, and is secondary to vitreous traction on necrotic retina and inflammatory membranes.25 The role of prophylactic laser photocoagulation to prevent RRD is unclear,26 and the optimal approach to vitrectomy for RRD remains difficult to ascertain.6 In recent years, surgical instrumentation and antiviral regimens have changed dramatically, and there is no single treatment strategy that has been identified as the standard of care. Moreover, no variables have been identified to be predictive of surgical success for RRD or prognostic of visual outcomes. This study investigated the long-term visual and anatomic outcomes in cases with RRD secondary to viral retinitis to determine effective medical treatment and surgical approaches in this challenging group of patients. Patients and methods The study protocol was approved by the University of Iowa Institutional Review Board for Human Subjects Research, and adhered to the tenets set forth in the Declaration of Helsinki.