Triamcinolone
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Cytomegalovirus retinitis following intravitreal administration: case report A 30-year-old man developed cytomegalovirus (CMV) retinitis following triamcinolone administration for panuveitis. The man, who had a 7-year history of Beh¸cet’s disease, received an intravitreal triamcinolone injection [dosage not stated] in his left eye after presenting with bilateral panuveitis in January 2008. He was started on corticosteroid treatment in combination with azathioprine. In March 2008, his visual acuity had improved. At the end of April 2008, 14 weeks after triamcinolone administration, his visual acuity was stable, and he was on prednisolone and azathioprine. However, his left eye contained diffuse fine and medium size keratic precipitates and 4+ cells in the anterior chamber with extensive necrotising retinitis. An opportunistic infection was considered; CMV retinitis was diagnosed. The man underwent a diagnostic pars plana vitrectomy, and received an intravitreal injection of ganciclovir. Cytomegalovirus DNA was discovered by PCR, and he was positive for serum anti-CMV IgG antibody. Interferon α-2a was introduced to treat his Beh¸cet’s uveitis, and prednisolone was tapered. On postoperative day 3, he received a second ganciclovir injection. Systemic treatment with IV ganciclovir was started 3 days later; he responded well and his necrotising retinitis had resolved completely in 3 weeks. Maintenance therapy was continued for 2 more weeks. Repeat PCR was negative for CMV DNA. In November 2008, he underwent cataract surgery with improvement in his left-eye visual acuity. Author comment: "We think that it was the local immunosuppression caused by intravitreal triamcinolone injection that led to the development of CMV retinitis." Tugal-Tutkun I, et al. CMV retinitis after intravitreal triamcinolone acetonide injection in a patient with Behcet’s uveitis. International Ophthalmology 30: 591-593, No. 5, Oct 2010. Available from: URL: http://dx.doi.org/10.1007/ 803046794 s10792-009-9332-9 - Turkey
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Reactions 8 Jan 2011 No. 1333
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