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Abstract
Purpose
We report a case of cytomegalovirus (CMV) retinitis following placement of an intravitreal dexamethasone implant in an immunocompetent patient diagnosed with non-infectious uveitis.
Case summary
A 60-year-old woman was referred to our hospital for recurrent anterior uveitis. Fundus examination and fluorescein angiography showed dense vitritis, but no definite retinal infiltration. After laboratory examinations, the patient was diagnosed with non-infectious panuveitis. Uveitis was much improved after the patient started taking oral steroid medication. However, the patient complained of systemic side effects from the oral steroids. Medication was stopped, and an intravitreal dexamethasone implant was fitted to address worsening inflammation. Two months later, perivascular retinal infiltration developed and vitritis recurred. Viral retinitis was suspected, and the patient underwent diagnostic vitrectomy adjunctive with intravitreal ganciclovir injection. Polymerase chain reaction of vitreous fluid confirmed the diagnosis of CMV retinitis. The patient has remained inflammation-free for more than 20 months after vitrectomy, single ganciclovir injection, and 2 months of oral valganciclovir medication.
Conclusions
This is a case report of CMV retinitis following placement of an intravitreal dexamethasone implant in an immunocompetent patient without any risk factors or previous history of immunosuppression. Potential risk factors for CMV retinitis should be evaluated and careful follow-up should be performed when intravitreal dexamethasone injections are unavoidable for the treatment of non-infectious uveitis.
Figures and Tables
Figure 1
A 60-year-old woman with no previous medical history presented with visual disturbance of the left eye. (A) Fundus examination showed dense vitritis without retinal infiltration. (B) Fluorescein angiography showed diffuse retinal vascular leakage and disc leakage. (C) After 3 weeks of oral steroid treatment, vitritis was improved. (D–E) Compared to the initial optical coherence tomography (OCT) image (D), OCT image 3 weeks after treatment (E) showed improvement of media opacity and normal retinal structure at macula.
Figure 2
Intravitreal dexamethasone implantation was performed for the recurrence of vitritis after oral steroid tapering. (A) Fundus examination showed the recurrence of vitritis after oral steroid tapering. (B) After 2 weeks of intravitreal dexamethasone implant, vitritis was improved. (C) After 2 months of dexamethasone implant, perivascular retinal infiltrations were newly developed and vitritis was aggravated. (D) Fluorescein angiography showed occlusive vasculopathy and vasculitis, which suggest the possibility of viral retinitis.
Figure 3
Images of post-vitrectomy with endolaser photocoagulation and intravitreal ganciclovir injection. (A) Fundus examinations 2 weeks after vitrectomy showed improved vitritis and retinal infiltration. (B) Fluorescein angiography at postoperative 2 months showed much improved vascular leakage. (C) Fundus photography 20 months after vitrectomy showed inflammation-free vitreous and retina and stable laser scars. (D–E) Optical coherence tomography at two weeks (D) and 20 months (E) after vitrectomy show normal retinal structure at macula.
Notes
References
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