Necrotizing herpetic retinopathy after intravitreal triamcinolone acetonide injection
Robert A Sisk1, Robert K Hutchins
1From the *Department of Ophthalmology, University of Cincinnati College of Medicine, and the †Cincinnati Eye Institute, Cincinnati, Ohio.
Purpose:
To report a new complication of intravitreal triamcinolone acetonide (TA) injection.
Methods:
In this observational case report, an 87-year-old woman received an intravitreal injection of TA as an adjunct to photodynamic therapy for wet age-related macular degeneration in the left eye. Four months later, she developed ipsilateral necrotizing herpetic retinopathy (NHR).
Results:
Retinal whitening of the macula was noted in the absence of vitritis that progressed over 5 days to diffuse retinitis with moderate vitritis and anterior chamber cell. Visual acuity decreased from 20/30 to 20/400. TA was still present inferiorly in the vitreous cavity. Polymerase chain reaction testing of samples obtained by vitrectomy with vitreous aspiration and retinal biopsy demonstrated varicella-zoster virus DNA. Two weeks later, repeated vitrectomy, silicone oil injection, and implantation of a ganciclovir sustained-release device were performed. Final visual acuity was 5/200.
Conclusions:
NHR can develop as a complication of intravitreal TA injection in an eye with a history of herpes zoster ophthalmicus.
