Viral retinitis following intraocular or periocular corticosteroid administration: A case series and comprehensive review of the literature

Ako Takakura, Howard H. Tessler, Debra A. Goldstein, Yan Guex-Crosier, Chi Chao Chan, Diane M. Brown, Jennifer E. Thorne, Robert Wang, Emmett T. Cunningham*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

37 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)175-182
Number of pages8
JournalOcular Immunology and Inflammation
Volume22
Issue number3
DOIs
StatePublished - Jun 2014

Keywords

  • Acute retinal necrosis
  • Corticosteroid
  • Cytomegalovirus
  • Herpes virus
  • Injection
  • Retinitis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Ophthalmology

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