Cytomegalovirus retinitis after subtenon triamcinolone acetonide and intravitreal injection of anti-vascular endothelial growth factor in an immunocompetent patient with age-related macular degeneration and diabetes mellitus

Cytomegalovirus Retinitis Following Intravitreal Triamcinolone Acetonide in a Patient with Chronic Uveitis on Systemic Immunosuppression

“…5 To our knowledge this is the second report of CMV retinitis following IVTA in a younger, HIVnegative patient on systemic immunosuppression for chronic uveitis. In our patient, the indication for IVTA was persistent macular edema following cataract surgery in a quiescent uveitic eye, while in previously reported cases there was a variety of indications, including persistent macular edema following a branch retinal vein occlusion, 1 diabetic macular edema, 2 age-related macular edema with choroidal neovascularisation, 3,4 central retinal vein occlusion, 4 and severe panuveitis due to Behçet disease. 5 This case report highlights the potential danger of the reactivation of latent CMV in younger, iatrogenically immunosuppressed individuals receiving additional local immunosuppression through intraocular long-acting corticosteroid injections.…”

“…Previously reported cases of CMV retinitis following TA have been described, mostly in elderly diabetics [1][2][3][4] and once before in a 30-year-old with Behçet disease on chronic high-dose azathioprine and corticosteroids. 5 To our knowledge this is the second report of CMV retinitis following IVTA in a younger, HIVnegative patient on systemic immunosuppression for chronic uveitis.…”

“…In our patient the CMV retinitis manifested 6 months after the IVTA injection and in previously reported cases the range of presentation was 3-9 months. [1][2][3][4][5] Given that the maximum immunosuppressive effect of triamcinolone in the vitreous is around 2-3 months, it is likely that the CMV retinitis was in fact present earlier than the eventual clinical manifestation and that the vitreous haze present was a manifestation of immune recovery uveitis. This delayed manifestation of a sight-threatening complication compels clinicians to perform periodic fundoscopy for up to 9 months after the IVTA injection in these susceptible individuals.…”

“…Recent reports have emerged of CMVR following intravitreal injections of TA in HIV-negative patients. [1][2][3][4][5] We describe a case of CMVR in an HIVnegative patient on long-term azathioprine therapy for unilateral, chronic, idiopathic panuveitis who developed severe sight-threatening CMVR following a single 4-mg intravitreal injection of TA.…”

Anti-VEGF Therapy With Bevacizumab for Anterior Segment Eye Disease

“…[171][172][173] There are also reports of abortion, 174 fever, 175 and reactivation of ocular viral infections, including herpetic epithelial keratitis 176 and cytomegalovirus retinitis, 177 after intravitreal injection of bevacizumab. The possible mechanisms that lead to these complications requires further evaluation.…”