First Author: T.Ozturk TURKEY
Co Author(s): N. Kocak M. Kaya O. Takes S. Kaynak 0 0 0 0 0 0 0 0 0
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To present a case with acute retinal necrosis (ARN) developed soon after intravitreal Ozurdex implantation for the treatment of retinal involvement of systemic vasculitis.
Department of Ophthalmology, Dokuz Eylul University School of Medicine, Izmir, Turkey.
A 51-year-old female with right phthisis bulbi was presented with diminished vision in her left eye. Medical history clarified that phthisis bulbi and total visual loss had occured secondary to recalcitrant uveitis 16 years ago. She had been on pulse steroid regimen combined with peroral methothrexate treatment for one day, as acute exacerbation of systemic vasculitis was diagnosed. Complete ophthalmologic examination including optic coherence tomography (OCT) and fluorescein angiography (FA) was performed in the presented case.
Best-corrected visual acuity (BCVA) of the left eye was 20/30 whereas no light perception was present in the fellow eye. Slit-lamp biomicroscopy revealed mild flare in the anterior chamber of the affected eye, besides retinal edema located to the inferior half of the posterior pole was detected via OCT, and retinal vasculopathy was diagnosed on FA. On the second day of hospitalization, 20/200 of BCVA was found in the left eye with severe macular edema and intravitreal Ozurdex implantation was scheduled, however visual acuity decreased to hand motion at the second postoperative day. Pars plana vitrectomy combined with Ozurdex extraction and silicone oil tamponade was performed at the seventh day of hospitalization, since ARN was diagnosed according to multiple choroidoretinal atrophic lesions determined on both dilated fundoscopy and FA. After the detection of herpes simplex virus (HSV) DNA in vitreous tap using polymerase chain reaction (PCR), systemic steroid treatment was stopped and intravitreal gancyclovir (0.2 mg/0.1 cc) injection was applicated with parenteral acyclovir (2 g/d) therapy subsequently. Monthly follow-up has been ongoing with a slight visual recovery.
The development of awesome ARN may be seen after intravitreal Ozurdex implantation. To the best of our knowledge, this is the first case with ocular herpes disease developed soon after intravitreal application of such dexamethasone implant.