J Korean Ophthalmol Soc.  2020 Jan;61(1):111-115. 10.3341/jkos.2020.61.1.111.

Retinal Toxicity Following the Injection Ganciclovir into Silicone Oil-filled Eye to Treat Acute Retinal Necrosis

• Jo YJ
• Choi SK
• Park SH
• Lee JJ
• Lee JE
• Park SW

• KMID: 2468484
• DOI: http://doi.org/10.3341/jkos.2020.61.1.111

Abstract

PURPOSE
To report a case of retinal toxicity after an intravitreal ganciclovir injection to treat acute retinal necrosis in an eye filled with silicone oil.
CASE SUMMARY
A 56-year-old male presented with ocular pain and visual loss in his right eye. His best-corrected visual acuity was 20/25, inflammatory cells in the anterior chamber, multiple retinitis lesions and retinal vessel occlusions in the peripheral retina and vitreous opacity were showed. Acute retinal necrosis was suspected, anterior chamber polymerase chain reaction (PCR) test was done. Aciclovir 2,400 mg/day intravenously and ganciclovir 2.0 mg were administered by intravitreal injection. After 4 days, retinitis was worsened and PCR test was positive for varicella zoster virus. Ganciclovir intravitreal injections were increased twice a week. After 16 days, retinal detachment occurred, so scleral encircling, vitrectomy, laser photocoagulation, and silicone oil tamponade were conducted. Ganciclovir 1.0 mg was injected at the end of surgery. The patient's visual acuity decreased to hand motion, and multiple crystal deposits with multiple retinal hemorrhages were observed in the right eye the next day. Visual acuity did not recover and optical coherent tomography showed that the macula was thinned.
CONCLUSIONS
Visual loss seemed to be related with the retinal toxicity of ganciclovir. The increased local concentration due to the silicone oil tamponade is thought to have caused the toxicity.

Keyword

Ganciclovir; Retinal necrosis syndrome and acute; Retinal toxicity

MeSH Terms

Acyclovir
Anterior Chamber
Ganciclovir*
Hand
Herpesvirus 3, Human
Humans
Intravitreal Injections
Light Coagulation
Male
Middle Aged
Polymerase Chain Reaction
Retina
Retinal Detachment
Retinal Hemorrhage
Retinal Necrosis Syndrome, Acute*
Retinal Vessels
Retinaldehyde*
Retinitis
Silicon*
Silicones*
Visual Acuity
Vitrectomy
Acyclovir
Ganciclovir
Retinaldehyde
Silicon
Silicones

Figure

• 

  Figure 1 Ultra-widefield fundus image at the initial visit. Multiple retinal opaque was presented in the periphery. Mild vitreous haziness and retinal vasculitis were combined.

• 

  Figure 2 Ultra-widefield fundus image and optical coherent tomography at the sixteen day after (A) retinal detachment with giant retinal tear were noticed in the fundus examination. (B) Optical coherence tomography showed fovea center was not involved.

• 

  Figure 3 Fundus photo and optical coherent tomography at the next day of the surgery (A) multiple crystal deposit with multiple retinal hemorrhages was noticed on the fundus examination. (B) Optical coherence tomography showed severe macular edema.

• 

  Figure 4 Ultra-widefield fundus image and optical coherent tomography at the sixth months after (A) there were no necrotic lesion, inflammation and retinal detachment on the fundus examination. (B) Optical coherence tomography image showed thinned macula.

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