A 63-year-old, female patient with known diabetes mellitus for approximately 20 years has been followed up for 6 years due to non-proliferative diabetic retinopathy. The patient received 3 doses of intravitreal bevacizumab and 8 doses of dexamethasone implant during the 6-year follow-up period. Before the 8th dexamethasone implantation, visual acuity was 0.1 and macular edema was observed in OCT.
In the 3rd week control visit after dexamethasone implantation, the visual acuity increased to 0.4 and macular edema improved significantly.
The patient presented with decreased vision, pain and photophobia in the 2nd month after implantation, and visual acuity was measured as 1 mps and intraocular pressure as 36mmHg. In the anterior segment examination, dirty granulomatous keratic precipitates and 4+ anterior chamber cells were observed, and the posterior segment was blurred.
Considering infectious causes, anterior chamber PCR was performed, topical steroids & cycloplegic agents, antiglaucomatous treatment was administered with oral valacyclovir at a dose of 3x2000mg. CMV was reported positive as a result of anterior chamber PCR. Intravenous ganciclovir at a dose of 5mg/kg x2 for 14 days followed by 900mg/day oral valganciclovir treatment was planned. No additional systemic steroid was administered. When the posterior segment became visible, a granular retinitis area was detected in the superior temporal area in addition to exudations secondary to diabetic retinopathy.
A significant regression was observed in the retinitis foci in the first month of treatment.
CMV retinitis is a viral, necrotizing retinitis that occurs on the basis of local or systemic immunosuppression. It can present in 3 forms: fulminant, slowly progressive granular and perivascular (with frozen branch angiitis) types, where hemorrhage is prominent. Diagnosis is made by demonstrating the virus in PCR analysis of ocular fluids in the light of clinical findings. The retinitis area resolves from the middle part. After treatment, mild pigmentary changes remain, and no significant chorioretinal scar develops.
Credit: Merve İnanç Tekin, M.D., from Ulucanlar Eye Training and Research Hospital
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