Acute retinal necrosis following dexamethasone intravitreal implant (Ozurdex®) administration in an immunocompetent adult with a history of HSV encephalitis: a case report

Abstract

Background: Dexamethasone intravitreal implants (0.7 mg) (Ozurdex®, Allergan Inc., Madison, NJ) are FDA approved for managing macular oedema (ME) of retinal vein occlusion (RVO). The major complications associated with intravitreal Ozurdex® implant include increased intraocular pressure and cataract progression. In regard to the occurrence of retinal complications, we report an unusual intravitreal Ozurdex® implantation-related acute retinal necrosis (ARN). Case presentation: A 45-year-old immunocompetent woman with a history of encephalitis presented with photophobia, redness, floaters, and rapidly decreased vision in her left eye. Three and six months ago, she received two doses of intravitreal Ozurdex® implant for ME of RVO. Clinical evaluation, including slit-lamp biomicroscopy, retinal photography, and fluorescein angiography, revealed anterior chamber cells, granulomatous keratic precipitates, cells in the vitreous, optic disc oedema, occlusive retinal vasculitis, scattered retinal haemorrhages, one quadrant of peripheral white areas with retinal necrosis, optic disc and vessels fluorescein staining, and retinal nonperfusion zones. All the above clinical manifestations showed an ARN. Herpes simplex virus was detected in the aqueous and vitreous humour by quantitative polymerase chain reaction testing. Intravenous acyclovir 500 mg tid for 7 days followed by oral valcyclovir was immediately performed for ARN. At 4 months, the patient's condition improved without retinal detachment, and the best-corrected visual acuity remained stable at 0.3. Conclusions: ARN might represent a risk of Ozurdex® administration.

Analysis of clinical characteristics of central nervous system varicella-zoster virus infection: A Single-Center Cases Series Study

“…Glucocorticoids may play a positive role because it can reduce brain edema and inhibit excessive in ammation [22,23]. However, immunosuppression induced by glucocorticoid is conducive to virus replication which may also affect the disease outcome [24][25][26]. Piret J recommended that administration of adjunctive immunomadulatory drugs should be initiated during the rise of the in ammatory response [27].…”

Diagnostic and therapeutic challenges in acute retinal necrosis; an update

“…Additionally, ARN has been linked to COVID-19 vaccination, as reported by other researchers [ 91 ]. Other potential causes of ARN reported in the literature include herpes zoster vaccination [ 92 ], cervical epidural steroid injection [ 93 ], intravitreal dexamethasone implant [ 94 ], cataract surgery [ 95 ], and intravitreal ranibizumab for exudative macular degeneration [ 96 ].…”