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Cytomegalovirus retinitis after intravitreous triamcinolone injection in a patient with central retinal vein occlusion.

Park YS, Byeon SH - Korean J Ophthalmol (2008)

Bottom Line: The PCR test was positive for CMV DNA.Other tests for infective uveitis and immune competence were negative.CMV retinitis is a rare complication of local immunosuppression with IVTA.

View Article: PubMed Central - PubMed

Affiliation: Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
To report a case of cytomegalovirus (CMV) retinitis after intravitreal injection of triamcinolone acetonide (IVTA). A 77-year-old woman with macular edema due to central retinal vein occlusion (CRVO) developed peripheral retinitis 4 months after IVTA. A diagnostic anterior chamber paracentesis was performed to obtain DNA for a polymerase chain reaction (PCR) test for viral retinitis. The PCR test was positive for CMV DNA. Other tests for infective uveitis and immune competence were negative. Four months after presentation, gancyclovir was intravitreously injected a total of 5 times, and the retinitis resolved completely. CMV retinitis is a rare complication of local immunosuppression with IVTA. It can be managed with timely injection of intravitreal gancyclovir until recovery from local immunosuppression.

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Related in: MedlinePlus

Cytomegalovirus (CMV) retinitis 4 months after intravitreous injection of triamcinolone acetonide (IVTA). The patient initially presented with blurred vision and ghost vessels, multiple retinal hemorrhages, and peripheral retinitis.
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Figure 1: Cytomegalovirus (CMV) retinitis 4 months after intravitreous injection of triamcinolone acetonide (IVTA). The patient initially presented with blurred vision and ghost vessels, multiple retinal hemorrhages, and peripheral retinitis.

Mentions: A 77-year-old woman with a history of hypertension was referred to our clinic in September 2006 for a 2-week history of blurred vision in her right eye. She had received an intravitreal injection of 4 mg of triamcinolone acetonide in her right eye for macular edema due to central retinal vein occlusion (CRVO) 4 months previously. Her right eye visual acuity was significant for light perception only, and ophthalmic examination of the right eye showed many cells in the anterior chamber and vitreous, multiple retinal hemorrhages and peripheral circumferential retinitis (Fig. 1). Serologic tests for infectious uveitis caused by herpes zoster virus (HZV), herpes simplex virus (HSV), CMV, toxoplasmosis, and syphilis (VDRL), and a test for human immunodeficiency virus, were performed. The patient tested seronegative for HZV, HSV, CMV, toxoplasma, and HIV, and VDRL was non-reactive. Before starting an oral corticosteroid, intravenous injection of acyclovir (2000 mg/day 4 times a day) was started. Because of a presumed diagnosis of acute retinal necrosis or CMV retinitis, diagnostic anterior chamber paracentesis was performed, and an aqueous humor sample was sent for analysis by polymerase chain reaction (PCR) for HZV, HSV, CMV and toxoplasmosis. An intravitreous gancyclovir injection (1.7 mg) was performed immediately after aqueous sampling. The aqueous humor PCR sample tested positive only for CMV.


Cytomegalovirus retinitis after intravitreous triamcinolone injection in a patient with central retinal vein occlusion.

Park YS, Byeon SH - Korean J Ophthalmol (2008)

Cytomegalovirus (CMV) retinitis 4 months after intravitreous injection of triamcinolone acetonide (IVTA). The patient initially presented with blurred vision and ghost vessels, multiple retinal hemorrhages, and peripheral retinitis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2629937&req=5

Figure 1: Cytomegalovirus (CMV) retinitis 4 months after intravitreous injection of triamcinolone acetonide (IVTA). The patient initially presented with blurred vision and ghost vessels, multiple retinal hemorrhages, and peripheral retinitis.
Mentions: A 77-year-old woman with a history of hypertension was referred to our clinic in September 2006 for a 2-week history of blurred vision in her right eye. She had received an intravitreal injection of 4 mg of triamcinolone acetonide in her right eye for macular edema due to central retinal vein occlusion (CRVO) 4 months previously. Her right eye visual acuity was significant for light perception only, and ophthalmic examination of the right eye showed many cells in the anterior chamber and vitreous, multiple retinal hemorrhages and peripheral circumferential retinitis (Fig. 1). Serologic tests for infectious uveitis caused by herpes zoster virus (HZV), herpes simplex virus (HSV), CMV, toxoplasmosis, and syphilis (VDRL), and a test for human immunodeficiency virus, were performed. The patient tested seronegative for HZV, HSV, CMV, toxoplasma, and HIV, and VDRL was non-reactive. Before starting an oral corticosteroid, intravenous injection of acyclovir (2000 mg/day 4 times a day) was started. Because of a presumed diagnosis of acute retinal necrosis or CMV retinitis, diagnostic anterior chamber paracentesis was performed, and an aqueous humor sample was sent for analysis by polymerase chain reaction (PCR) for HZV, HSV, CMV and toxoplasmosis. An intravitreous gancyclovir injection (1.7 mg) was performed immediately after aqueous sampling. The aqueous humor PCR sample tested positive only for CMV.

Bottom Line: The PCR test was positive for CMV DNA.Other tests for infective uveitis and immune competence were negative.CMV retinitis is a rare complication of local immunosuppression with IVTA.

View Article: PubMed Central - PubMed

Affiliation: Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
To report a case of cytomegalovirus (CMV) retinitis after intravitreal injection of triamcinolone acetonide (IVTA). A 77-year-old woman with macular edema due to central retinal vein occlusion (CRVO) developed peripheral retinitis 4 months after IVTA. A diagnostic anterior chamber paracentesis was performed to obtain DNA for a polymerase chain reaction (PCR) test for viral retinitis. The PCR test was positive for CMV DNA. Other tests for infective uveitis and immune competence were negative. Four months after presentation, gancyclovir was intravitreously injected a total of 5 times, and the retinitis resolved completely. CMV retinitis is a rare complication of local immunosuppression with IVTA. It can be managed with timely injection of intravitreal gancyclovir until recovery from local immunosuppression.

Show MeSH
Related in: MedlinePlus