Necrotizing herpetic retinopathy after intravitreal triamcinolone acetonide injection.

PURPOSE: To report a new complication of intravitreal triamcinolone acetonide (TA) injection.

METHODS

In this observational case report, an 87-year-old woman received an intravitreal injection of TA as an adjunct to photodynamic therapy for wet age-related macular degeneration in the left eye. Four months later, she developed ipsilateral necrotizing herpetic retinopathy (NHR).

RESULTS

Retinal whitening of the macula was noted in the absence of vitritis that progressed over 5 days to diffuse retinitis with moderate vitritis and anterior chamber cell. Visual acuity decreased from 20/30 to 20/400. TA was still present inferiorly in the vitreous cavity. Polymerase chain reaction testing of samples obtained by vitrectomy with vitreous aspiration and retinal biopsy demonstrated varicella-zoster virus DNA. Two weeks later, repeated vitrectomy, silicone oil injection, and implantation of a ganciclovir sustained-release device were performed. Final visual acuity was 5/200.

CONCLUSIONS

NHR can develop as a complication of intravitreal TA injection in an eye with a history of herpes zoster ophthalmicus.