Korean J Ophthalmol.  2011 Dec;25(6):451-454. 10.3341/kjo.2011.25.6.451.

Presumed Necrotizing Viral Retinitis after Intravitreal Triamcinolone Injection: Case Report

Affiliations
  • 1Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
  • 2Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. sejoon1@hanmail.net

Abstract

A 56-year-old man presented with anterior chamber inflammation, increased intraocular pressure, peripheral retinal infiltration, and generalized retinal arterial obstruction suggesting acute retinal necrosis five months after intravitreal triamcinolone acetonide injection (IVTA). He was treated with intravenous antiviral agents and aspirin. Shortly after treatment, retinal infiltrations were resolved, and partial recanalization of the obstructed vessel was observed. Viral retinitis may occur as an opportunistic infection following IVTA due to the local immune modulatory effect of the steroid; hence, close observation following IVTA is necessary.

Keyword

Acute retinal necrosis; Herpetic retinitis; Intravitreal injections; Intravitreal triamcinolone acetonide injection

MeSH Terms

Antiviral Agents/therapeutic use
Aspirin/therapeutic use
Drug Therapy, Combination
Humans
Intravitreal Injections
Male
Middle Aged
Opportunistic Infections/*chemically induced/virology
Retinal Necrosis Syndrome, Acute/*chemically induced/virology
Triamcinolone Acetonide/administration & dosage/*adverse effects

Figure

  • Fig. 1 Fundus photography of the right eye. (A) Before intravitreal injection of triamcinolone acetonide (IVTA), only mild diabetic changes can be seen. (B) Five months after IVTA, anterior chamber inflammation, severe arterial obstruction, and vitreous opacity developed.

  • Fig. 2 Montage fundus photography. (A) Five months after intravitreal triamcinolone acetonide injection, anterior chamber inflammation, severe arterial obstruction, and vitreous opacity developed. A white necrotic retinal area (black arrows) and vitreous opacity developed. Intravitreal triamcinolone is still visible in the inferior vitreous (white arrow). (B) After anti-viral treatment, the necrotic retinal area and vitreous opacity were gradually resolved. One month after antiviral medication, the white retinal necrotic area eventually disappeared.


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