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

Abstract

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.

Intravitreal dexamethasone implant for the treatment of cystoid macular oedema associated with acute retinal necrosis

“…Literature on use of intravitreal corticosteroid in ARN is sparse. In fact, local administration of corticosteroid has been implicated to reactivate viral retinitis [6–8]. However, in many of the cases reported, there were associated comorbidities and many of these patients were on immunosuppression for a long time [6].…”

Acute Retinal Necrosis After Intravitreal Triamcinolone Acetonide For Aphakic Macular Edema- A Case Report

“…This delay may lead to complications resulting in blindness. Poor vision usually is due to rhegmatogenous retinal detachment or optic neuritis [11][12][13].Risk factors for ARN include young age, history of neurosurgery, periocular trauma, compromised immune status, Adminstration of local immunosuppressives in the vitreous, and a history of viral retinitiA [12][13][14]. In our case patient was administered IVTA.…”

Cytomegalovirus Retinitis and Uveitis

“…[1][2][3] Localized immunosuppression following administration of periocular or intraocular corticosteroids can also be complicated by the development of CMVR in isolated cases. 4 Equally uncommon is CMV-associated anterior uveitis in non-HIV-positive patients, reports of which have emerged predominantly, although not exclusively, from Asia. 1,[5][6][7] Four research articles [8][9][10][11] in this issue of Ocular Immunology & Inflammation present important findings relevant to the clinical presentation, progression, and management of CMVassociated retinitis and uveitis.…”