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ACUTE RETINAL NECROSIS AFTER INTRAVITREAL DEXAMETHASONE IMPLANT. A CASE REPORT.

Z Šulavíková, J Anwarzai, V Krásnik

    Ceska a Slovenska Oftalmologie : Casopis Ceske Oftalmologicke Spolecnosti a Slovenske Oftalmologicke Spolecnosti
    |June 27, 2022
    PubMed
    Summary

    Acute retinal necrosis is a rare complication of Ozurdex® (dexamethasone intravitreal implant) treatment, especially in immunosuppressed patients. This case highlights the risk of cytomegalovirus reactivation following Ozurdex® implantation.

    Keywords:
    acute retinal necrosischronic myeloid leukemiadexamethasonediabetic macular edemadiabetic retinopathyhematopoietic stem cell transplantationimatinibimunosupression

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    Area of Science:

    • Ophthalmology
    • Virology
    • Immunology

    Background:

    • Ozurdex® (dexamethasone intravitreal implant) is used for diabetic macular edema, retinal vein occlusion, and non-infectious uveitis.
    • Common Ozurdex® complications include increased intraocular pressure and cataract progression.
    • Acute retinal necrosis is a very rare but serious complication of Ozurdex®.

    Observation:

    • A case report details an immunosuppressed 68-year-old male patient with diabetic macular edema.
    • The patient developed acute retinal necrosis 74 days post-Ozurdex® implantation.
    • The patient had chronic myeloid leukemia and was on imatinib therapy.

    Findings:

    • Urgent pars plana vitrectomy and intravenous antiherpetic drugs were administered.
    • Serological examination confirmed active cytomegalovirus (CMV) infection.
    • This is the fourth reported case of acute retinal necrosis after Ozurdex® administration.

    Implications:

    • Intravitreal corticosteroids like Ozurdex® can suppress local immune responses.
    • This immune suppression may trigger primary infections or reactivate latent viral infections.
    • Caution is advised when using Ozurdex® in immunosuppressed patients due to the risk of severe complications like CMV retinitis.