Takakura Ako, Tessler Howard H, Goldstein Debra A, Guex-Crosier Yan, Chan Chi-Chao, Brown Diane M, Thorne Jennifer E, Wang Robert, Cunningham Emmett T
Department of Ophthalmology, California Pacific Medical Center , San Francisco, California , USA .
Ocul Immunol Inflamm. 2014 Jun;22(3):175-82. doi: 10.3109/09273948.2013.866256. Epub 2014 Mar 21.
To describe viral retinitis following intravitreal and periocular corticosteroid administration.
Retrospective case series and comprehensive literature review.
We analyzed 5 unreported and 25 previously published cases of viral retinitis following local corticosteroid administration. Causes of retinitis included 23 CMV (76.7%), 5 HSV (16.7%), and 1 each VZV and unspecified (3.3%). Two of 22 tested patients (9.1%) were HIV positive. Twenty-one of 30 (70.0%) cases followed one or more intravitreal injections of triamcinolone acetonide (TA), 4 (13.3%) after one or more posterior sub-Tenon injections of TA, 3 (10.0%) after placement of a 0.59-mg fluocinolone acetonide implant (Retisert), and 1 (3.3%) each after an anterior subconjunctival injection of TA (together with IVTA), an anterior chamber injection, and an anterior sub-Tenon injection. Mean time from most recent corticosteroid administration to development of retinitis was 4.2 months (median 3.8; range 0.25-13.0). Twelve patients (40.0%) had type II diabetes mellitus. Treatments used included systemic antiviral agents (26/30, 86.7%), intravitreal antiviral injections (20/30, 66.7%), and ganciclovir intravitreal implants (4/30, 13.3%).
Viral retinitis may develop or reactivate following intraocular or periocular corticosteroid administration. Average time to development of retinitis was 4 months, and CMV was the most frequently observed agent. Diabetes was a frequent co-morbidity and several patients with uveitis who developed retinitis were also receiving systemic immunosuppressive therapy.
描述玻璃体内及眼周注射皮质类固醇激素后发生的病毒性视网膜炎。
回顾性病例系列研究及全面的文献综述。
我们分析了5例未报告及25例先前发表的局部使用皮质类固醇激素后发生病毒性视网膜炎的病例。视网膜炎的病因包括23例巨细胞病毒（CMV，76.7%）、5例单纯疱疹病毒（HSV，16.7%）、1例水痘带状疱疹病毒（VZV）及1例未明确病毒（3.3%）。22例接受检测的患者中有2例（9.1%）HIV阳性。30例病例中有21例（70.0%）在一次或多次玻璃体内注射曲安奈德（TA）后发生，4例（13.3%）在一次或多次Tenon囊下注射TA后发生，3例（10.0%）在植入0.59 mg氟轻松醋酸酯植入物（Retisert）后发生，1例（3.3%）分别在结膜下注射TA（联合玻璃体内注射TA）、前房注射及Tenon囊下注射后发生。从最近一次使用皮质类固醇激素至发生视网膜炎的平均时间为4.2个月（中位数3.8个月；范围0.25 - 13.0个月）。12例患者（40.0%）患有II型糖尿病。所采用的治疗方法包括全身抗病毒药物（26/30，86.7%）、玻璃体内抗病毒注射（20/30，66.7%）及更昔洛韦玻璃体内植入物（4/30，13.3%）。
眼内或眼周注射皮质类固醇激素后可能发生或重新激活病毒性视网膜炎。视网膜炎发生的平均时间为4个月，CMV是最常见的病原体。糖尿病是常见的合并症，数例发生视网膜炎的葡萄膜炎患者同时也在接受全身免疫抑制治疗。
