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TitelUnilateral cytomegalovirus panuveitis in a diabetic patient following an intravitreal injection of triamcinolone acetonide
DoelTo describe the case of a patient with cytomegalovirus (CMV) panuveitis following an intravitreal triamcinolone acetonide (IVTA) injection.
MethodesOphthalmic examination, blood analysis and diagnostic anterior chamber paracentesis.
ResultatenA 75-year-old man presented with a red and painful left eye. Eleven weeks ago, he underwent an IVTA injection for a severe diabetic retinopathy. Bilateral panretinal photocoagulation was done years ago. Vision in the right eye was 2/10 and 1/10 in the left eye. Slit-lamp examination revealed mutton fat keratic precipitates, 4+ cells and flare in the left anterior chamber. Intraocular pressure was 42 mmHg. Fundus examination showed extensive area of necrotizing retinitis associated with vitritis, optic disc edema, vasculitis and haemorrhages. Serologic testing for HIV, HSV and VZV was negative. Serum testing for CMV was postitive for IgG but IgM was undetectable. PCR detected CMV DNA in the aqueous humor in the affected eye. Intravenous ganciclovir was initiated, but was discontinued after a week due to a poor renal function. Ganciclovir was then given intravitreously on a weekly basis. Topical therapy included atropine, corticosteroid, beta-blocker and carbonic anhydrase inhibitor. Systemic carbonic anhydrase inhibitor was contra-indicated because of renal failure. Despite treatment, the retinal lesions didn't improve and the intraocular pressure remained high. The treatment was discontinued after four intravitreal injections of ganciclovir.
ConclusieCMV retinitis is a potentially devastating complication of IVTA injection. Local immunosuppression in the vitreous with IVTA and the immunocompromised status related to diabetes mellitus may have caused CMV retinitis.
Auteur 1
NaamTEK
InitialenA
InstituutCHR Citadelle
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Auteur 2
NaamHUA
InitialenM-T
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Auteur 3
NaamBETZ
InitialenP
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Auteur 4
NaamBONNET
InitialenS
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