Purpose
To describe viral retinitis following intravitreal and periocular
corticosteroid administration.
Methods
Retrospective case series and comprehensive literature review.
Results
We analyzed 5 unreported and 25 previously published cases of viral
retinitis following local corticosteroid administration. Causes of retinitis
included 23 CMV (76.7%), 5 HSV (16.7%), and 1 each VZV and
unspecified (3.3%). Two of 22 tested patients (9.1%) were
HIV positive. Twenty-one of 30 (70.0%) cases followed one or more
intravitreal injections of triamcinolone acetonide (TA), 4 (13.3%)
after one or more posterior sub-Tenon injections of TA, 3 (10.0%)
after placement of a 0.59-mg fluocinolone acetonide implant (Retisert), and
1 (3.3%) each after an anterior subconjunctival injection of TA
(together with IVTA), an anterior chamber injection, and an anterior
sub-Tenon injection. Mean time from most recent corticosteroid
administration to development of retinitis was 4.2 months (median 3.8; range
0.25–13.0). Twelve patients (40.0%) had type II diabetes
mellitus. Treatments used included systemic antiviral agents (26/30,
86.7%), intravitreal antiviral injections (20/30, 66.7%),
and ganciclovir intravitreal implants (4/30, 13.3%).
Conclusions
Viral retinitis may develop or reactivate following intraocular or
periocular corticosteroid administration. Average time to development of
retinitis was 4 months, and CMV was the most frequently observed agent.
Diabetes was a frequent co-morbidity and several patients with uveitis who
developed retinitis were also receiving systemic immunosuppressive
therapy.
PurposeTuberculous optic neuropathy may follow infection with Mycobacterium tuberculosis or administration of the bacille Calmette–Guerin. However, this condition is not well described in the ophthalmic literature.MethodsOphthalmologists, identified through professional electronic networks or previous publications, collected standardized clinical data relating to 62 eyes of 49 patients who they had managed with tuberculous optic neuropathy.ResultsTuberculous optic neuropathy was most commonly manifested as papillitis (51.6 %), neuroretinitis (14.5 %), and optic nerve tubercle (11.3 %). Uveitis was an additional ocular morbidity in 88.7 % of eyes. In 36.7 % of patients, extraocular tuberculosis was present. The majority of patients (69.4 %) had resided in and/or traveled to an endemic area. Although initial visual acuity was 20/50 or worse in 62.9 % of 62 eyes, 76.7 % of 60 eyes followed for a median of 12 months achieved visual acuities of 20/40 or better. Visual field defects were reported for 46.8 % of eyes, but these defects recovered in 63.2 % of 19 eyes with follow-up.ConclusionVisual recovery from tuberculous optic neuropathy is common, if the diagnosis is recognized and appropriate treatment is instituted. A tuberculous etiology should be considered when evaluating optic neuropathy in persons from endemic areas.
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