Presumed necrotizing viral retinitis after intravitreal triamcinolone injection: case report

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.

Keywords: Acute retinal necrosis; Herpetic retinitis; Intravitreal injections; Intravitreal triamcinolone acetonide injection.

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.