J Korean Ophthalmol Soc.  2013 Jun;54(6):977-981. 10.3341/jkos.2013.54.6.977.

Two Cases of Intravitreal Ganciclovir Injection for Cytomegalovirus Retinitis

• Han JB
• Lee SW
• Kwak HW

• KMID: 2217278
• DOI: http://doi.org/10.3341/jkos.2013.54.6.977

Abstract

PURPOSE
To report 2 cases of cytomegalovirus retinitis treated with intravitreal ganciclovir.
CASE SUMMARY
A 29-year-old female (Case 1) who received immunosuppressive therapy with tacrolimus and mycophenolate mofetil for 3 months after pancreatic transplantation, was given an intravitreal Bevacizumab injection 4 times in each eye under the suspicion of bilateral central retinal vein occlusion. During follow-up, a new lesion with white opacification and multiple snowballs appeared in the left eye. Suspecting cytomegalovirus retinitis, we administered an intravitreal ganciclovir injection resulting in a decrease of white opacification and improvement of visual acuity. A 66-year-old male (Case 2) who was receiving treatment for general weakness and heart failure, presented with visual disturbance in both eyes. Fundoscopic examination revealed white opacification, multiple snowballs and retinal hemorrhage in the left eye; diagnostic vitrectomy was performed. Macular edema and subretinal fluid continued after the vitrectomy and the serologic testing revealed an IgG titer positive for cytomegalovirus, therefore, an intravitreal injection of ganciclovir was given. Macular edema and subretinal fluid decreased and visual acuity improved.
CONCLUSIONS
Intravitreal ganciclovir can be an effective treatment option for the management of CMV retinitis.

Keyword

Cytomegalovirus retinitis; Ganciclovir; Intravitreal ganciclovir injection

MeSH Terms

Antibodies, Monoclonal, Humanized
Cytomegalovirus
Cytomegalovirus Retinitis
Eye
Female
Follow-Up Studies
Ganciclovir
Heart Failure
Humans
Immunoglobulin G
Intravitreal Injections
Macular Edema
Male
Mycophenolic Acid
Retinal Hemorrhage
Retinal Vein
Retinitis
Serologic Tests
Subretinal Fluid
Tacrolimus
Transplants
Visual Acuity
Vitrectomy
Bevacizumab
Antibodies, Monoclonal, Humanized
Ganciclovir
Immunoglobulin G
Mycophenolic Acid
Tacrolimus

Figure

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  Figure 1. Fundus photographs & OCT of both eyes in case 1. (A) Fundus photograph of the left eye shows opaque white lesions at the inferonasal retina. (B) Fundus photograph of the left eye shows disappearance of opaque white lesions. (C) OCT of left eye shows residual macular edema. (D) OCT of left eye shows residual macular edema.

• 

  Figure 2. Fundus photographs & OCT of both eyes in case 2. (A) Fundus photograph of right eye shows retinal hemorrhage with opaque white lesions in inferior region of the optic disc and atrophic lesions at the temporal region. (B) Fundus photo-graph of the right eye shows improvement of retinal hemorrhage with opaque white lesions. (C) OCT of the right eye shows macular edema and submacular fluid. (D) OCT of the right eye shows no macular edema and submacular fluid.

Reference

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