J Korean Ophthalmol Soc.  2016 Dec;57(12):1976-1980. 10.3341/jkos.2016.57.12.1976.

Treatment of Acute Retinal Necrosis with Acute Kidney Injury after Intravenous Antiviral Injection

• Hwang SJ
• Kim DR
• Kang MH
• Seong MC
• Cho HY
• Shin YU

• KMID: 2362719
• DOI: http://doi.org/10.3341/jkos.2016.57.12.1976

Abstract

PURPOSE
In the present study, a case of acute retinal necrosis with acute renal injury due to high-dose intravenous antiviral injection which was treated by intravitreal ganciclovir injection is reported.
CASE SUMMARY
A 46-year-old female visited our clinic complaining of red eye and decreased vision in the right eye. At the first visit, her corrected visual acuity was finger count in the right eye, and 20/20 in the left eye. Fundus examination of the right eye revealed multiple peripheral arterial occlusion, papilledema, and whitish necrotic infiltration at the periphery. Clinically diagnosed as acute retinal necrosis, the patient was started on intravenous acyclovir. Two days after injection, her serum creatinine level increased, therefore, intravenous acyclovir was discontinued and she was started on intravitreal ganciclovir. Five days after the intravenous injection was discontinued, the serum creatinine level returned to normal range. Four months after the first visit, visual acuity was 20/100 and no recurrence was observed.
CONCLUSIONS
Intravitreal ganciclovir injection can be an effective alternative in patients with acute retinal necrosis and poor kidney function.

Keyword

Acute renal injury; Acute retinal necrosis; Acyclovir; Antiviral; Ganciclovir

MeSH Terms

Acute Kidney Injury*
Acyclovir
Creatinine
Female
Fingers
Ganciclovir
Humans
Injections, Intravenous
Kidney
Middle Aged
Papilledema
Recurrence
Reference Values
Retinal Necrosis Syndrome, Acute*
Visual Acuity
Acyclovir
Creatinine
Ganciclovir

Figure

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  Figure 1. Fundus photograph and fluorescein angiography at initial visit. Confluent, whitish, and necrotic infiltrations are seen around peripheral retina. Obstructive arteritis, vitreous haziness and disc edema are also observed.

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  Figure 2. Fundus photographs after administration. (A) Hospital day #2. After intravenous acyclovir, the progression of the diseases was stopped, however, acyclovir-induced acute renal injury was occurred. (B) Hospital day #7. Instead of IV acyclovir, intravitreal gancyclovir was performed 2 times per week. The area of infiltrations began to decrease.

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  Figure 3. Chronologic order of ultrawide fundus images during the patient's clinical course. (A) One month after initial visit. Peripheral confluent whitish lesions were moved to more peripheral area. At that time, 360° barrier laser was done. 6 week (B) and 8 weeks (C) later, peripheral infiltrations were significantly improved. 3 months later (D), no infiltration was observed.

Reference

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