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Case Report: Acute Retinal Necrosis after Intravitreal Ranibizumab for Exudative Macular Degeneration.

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    Acute retinal necrosis (ARN) can occur after intravitreal ranibizumab (IVR) for age-related macular degeneration (AMD). Early detection of viral DNA is crucial for prompt antiviral treatment to prevent vision loss.

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    Area of Science:

    • Ophthalmology
    • Virology

    Background:

    • Exudative age-related macular degeneration (AMD) is a common condition treated with intravitreal ranibizumab (IVR).
    • Acute retinal necrosis (ARN) is a rare but severe complication that can arise post-IVR.

    Observation:

    • A 67-year-old male with exudative AMD developed varicella-zoster virus-associated ARN three days after IVR.
    • The patient required systemic and intravitreal antiviral therapy, vitrectomy with silicone oil, and subsequent management for complications including retinal detachment.

    Findings:

    • This case represents the first report of varicella-zoster virus-associated ARN following IVR.
    • Distinguishing early ARN from post-IVR inflammation can be challenging.

    Implications:

    • Early identification of ARN post-IVR is critical.
    • Polymerase chain reaction (PCR) for viral DNA in ocular fluid is recommended for prompt diagnosis.
    • Timely antiviral intervention may prevent irreversible visual impairment.