Necrotizing retinitis after intravitreal injection of triamcinolone

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Necrotizing retinitis after intravitreal injection of triamcinolone Juan Davó Cabrera Enrique Alfonso Muñoz FOM

CASE REPORT A 47-year-old man with a decreased VA for 3 months in right eye. Fundus examination: Epiretinal membrane next to a retinal scar. It was performed a pars plana vitrectomy removing epiretinal membrane without complications and injecting intravitreal (iv) triamcinolone at the end of surgery.

CASE REPORT 1 month after surgery the patient presented in emergency room because of pain in right eye and a decrease in VA. In the slit lamp, granulomatous uveitis was observed with vitritis and a central necrotizing retinitis. Aqueous humor samples were obtained and iv Foscarnet injected.

CASE REPORT Aqueous humor samples were obtained and iv Foscarnet was injected (suspect of acute retinal necrosis). PCR was negative for herpes simplex virus, varicella zoster virus, CMV, EB and positive for T. gondii Iv clindamycin was performed and repeated after 1 week

CONCLUSION Acute retinal necrosis is the most frequent cause of necrotizing retinitis in inmmunocompetent patients. However, intravitreal triamcinolone induces a local immnunocompromised environment that favors atypical forms such as Toxoplasmosis necrotizing retinitis.