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

Zaborowski, Anthony G.

doi:10.3109/09273948.2012.737889

Cited by 13 publications

(3 citation statements)

References 5 publications

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“…In one case, azathioprine was discontinued and 10mg of oral prednisone was continued. 24 In a second case, infliximab was discontinued and low-dose oral prednisone and methotrexate were continued. In a third case, both infliximab and mycophenolate mofetil were discontinued.…”

Section: Discussionmentioning

confidence: 99%

Viral Retinitis following Intraocular or Periocular Corticosteroid Administration: A Case Series and Comprehensive Review of the Literature

Takakura

Tessler

Goldstein

et al. 2014

Ocular Immunology and Inflammation

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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.

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Section: Discussionmentioning

confidence: 99%

Viral Retinitis following Intraocular or Periocular Corticosteroid Administration: A Case Series and Comprehensive Review of the Literature

Takakura

Tessler

Goldstein

et al. 2014

Ocular Immunology and Inflammation

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“…Human cytomegalo virus (HCMV) retinitis is an opportunistic infection commonly affecting naturally or iatrogenically immunocompromised patients/subjects [1,2]. HCMV is the leading cause of vision loss in subjects with low CD4 count (< 50 cell/mm 3 ) [3,4].…”

Section: Introductionmentioning

confidence: 99%

Synthesis and Characterization of Ganciclovir Long Chain Lipid Prodrugs

Mitra¹

2014

AOVS

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Ganciclovir (GCV) is indicated for the treatment of human cytomegalo virus (HCMV) retinitis in immunocompromised patients. Sub-optimal physicochemical properties prevent GCV from reaching therapeutic concentrations in back of the eye (retina) tissue after oral and intravenous administration. Chronic high dose administration results in systemic toxicity. Local intravitreal injections suffer from poor ocular bioavailability and require repeated administration which can cause retinal detachment, retinal/vitreal hemorrhage and endophthalmitis. In the current study, we synthesized long chain acyl ester derivatives of GCV to improve lipophilicity and bioavailability. Ester conjugates (C5, C10 and C13 mono- and di-(O-acyl)) of GCV were synthesized in one step reaction following conventional esterification reaction. Purity of the novel prodrugs was determined with reversed phase high performance liquid chromatography. Conjugation of long lipid chain to GCV was confirmed with proton (1H) and carbon (13C) nuclear magnetic resonance and mass spectroscopy. Also, melting point and lipophilicity for the prodrugs and GCV were determined. MTS assay was used to assess in vitro toxicity of GCV and its long chain lipid prodrugs on human retinal pigment epithelial cell line (ARPE-19) cells. Results indicated that long chain lipid GCV prodrugs are nontoxic, safe and well-tolerated by ARPE-19 cells. These results suggest that novel long chain lipid GCV prodrugs may be further evaluated for ocular delivery and treatment of HCMV retinitis.

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Section: Introductionmentioning

confidence: 99%

Untitled

2014

AOVS

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H) and carbon ( 13 C) nuclear magnetic resonance and mass spectroscopy. Also, melting point and lipophilicity for the prodrugs and GCV were determined. MTS assay was used to assess in vitrotoxicity of GCV and its long chain lipid prodrugs on human retinal pigment epithelial cell line (ARPE-19) cells. Results indicated that long chain lipid GCV prodrugs are nontoxic, safe and well-tolerated by ARPE-19 cells. These results suggest that novel long chain lipid GCV prodrugs may be further evaluated for ocular delivery and treatment of HCMV retinitis.

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

Cited by 13 publications

References 5 publications

Viral Retinitis following Intraocular or Periocular Corticosteroid Administration: A Case Series and Comprehensive Review of the Literature

Viral Retinitis following Intraocular or Periocular Corticosteroid Administration: A Case Series and Comprehensive Review of the Literature

Synthesis and Characterization of Ganciclovir Long Chain Lipid Prodrugs

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