Neuroretinitis With Severe Macular Edema in Dual Infection: Challenges in Management.

Area of Science:

• Ophthalmology
• Infectious Diseases
• Retinal Diseases

Background:

• Neuroretinitis is characterized by optic disc swelling and a macular star pattern.
• It is often associated with bacterial, parasitic, or viral infections.
• Severe macular edema can complicate neuroretinitis, posing a significant threat to vision.

Observation:

• A case of neuroretinitis with severe macular edema in a 49-year-old female is presented.
• The patient exhibited optic disc swelling, macular star, impaired optic nerve function, and vasculitis.
• Ocular coherence tomography confirmed macular edema, subretinal fluids, and an epiretinal membrane.

Findings:

• Serological tests revealed dual infections with Toxoplasma and herpes simplex virus type 1.
• Initial treatment with oral azithromycin, acyclovir, and corticosteroids did not fully resolve the macular edema.
• Intravitreal ranibizumab injection led to a significant reduction in subretinal fluids and improved outcomes.

Implications:

• This case highlights the potential for dual infections to cause severe neuroretinitis and macular edema.
• Intravitreal ranibizumab shows promise as an effective treatment for refractory macular edema in neuroretinitis.
• Further research is warranted to explore the role of anti-VEGF agents in managing complex neuroretinitis cases.