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Treatment Strategies for Neuroretinitis: Current Options and Emerging Therapies

  • Neurologic Ophthalmology and Otology (R Shin and D Gold, Section Editors)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

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.

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Authors and Affiliations

  1. Department of Ophthalmology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA

    Aaron M. Fairbanks MD, Matthew R. Starr MD, John J. Chen MD, PhD & M. Tariq Bhatti MD

  2. Department of Neurology, Mayo Clinic, Rochester, MN, USA

    John J. Chen MD, PhD & M. Tariq Bhatti MD

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Correspondence to M. Tariq Bhatti MD.

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Human and Animal Rights and Informed Consent

Dr. Bhatti participated in the following two studies that involved human subjects: Schmalfuss IM, Dean CW, Sistrom C, Bhatti MT. Optic neuropathy secondary to cat scratch disease: distinguishing MR imaging features from other types of optic neuropathies. AJNR Am J Neuroradiol. 2005;26 (6):1310–6; Chi SL, Stinnett S, Eggenberger E, Foroozan R, Golnik K, Lee MS, et al. Clinical characteristics in 53 patients with cat scratch optic neuropathy. Ophthalmology. 2012;119 (1):183–7.

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Note: Specific antibiotic dosing is provided in Table 2.

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Fairbanks, A.M., Starr, M.R., Chen, J.J. et al. Treatment Strategies for Neuroretinitis: Current Options and Emerging Therapies. Curr Treat Options Neurol 21, 36 (2019). https://doi.org/10.1007/s11940-019-0579-9

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