First Author: P.Gupta INDIA
Co Author(s): R. Chawla D. Sundar
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Severe macular oedema causing marked loss of vision is seen in cases of retinitis developing post-viral fever. The use of anti-VEGF agents for macular oedema and sub-macular fluid secondary to viral retinitis has not been studied or well established in the past. We report a case series of 2 patients of post-viral retinitis with severe macular oedema, successfully managed with bevacizumab
Out-patient department, Dr. Rajendra Prasad Centre of Ophthalmic Sciences, AIIMS, New Delhi, INDIA
Retrospective review of clinical findings, fundus imaging, optical coherence tomography and management strategy of 2 cases of severe macular edema post-viral retinitis. Sequential (2 days gap) intra-vitreal injection of bevacizumab (1.25mg) was given in both the eyes of both patients. Follow up was done at 1wk, 6wk,8wk and 12 week following the intravitreal injection.
Both patients presented with a bilateral, sudden, painless diminution of vision following an episode of viral fever. On presentation, the first patient had a best corrected visual acuity (BCVA) of finger counting close to face (FCCF) in the right eye (OD) and finger counting at 1 metre in the left eye (OS). The central macular thickness (CMT) was 1292µm OD and 853µm OS with evidence of macular edema. The second patient, on presentation had BCVA of finger counting at 3metre OD and FCCF OS. The CMT was 504µm OD and 1052µm OS. Fundus examination revealed multiple patches of retinitis and severe macular edema. The patients were previously treated elsewhere with oral anti-virals and steroids but didn’t respond to it. The patients showed significant symptomatic improvement in the visual acuity. The retinitis lesions resolved slowly and macular edema regressed. After 12 weeks, the first patient’s BCVA improved to 6/36 OD and 6/9 OS. The CMT also reduced to 153µm OD and 215µm OS . The second patient improved to 6/24 OD and 6/18 OS with CMT of 224µm OD and 184um OS.
Bevacizumab appears to be a safe and useful agent to manage macular oedema subsequent to post-viral retinitis. An early resolution of macular oedema helps in preservation of visual acuity which left untreated can cause severe visual loss. Similar studies with a larger number of cases may further help to establish the efficacy of this management strategy.