valacyclovir and Retinal-Vasculitis

We present a case of a patient that experienced severe hemorrhagic occlusive retinal vasculitis secondary to injection of 1.0 mg/0.1 ml of intracameral vancomycin for endophthalmitis prophylaxis after an uneventful cataract surgery. The case is especially unique in that our patient ended up maintaining 20/25 vision with an ocular disease that is typically visually threatening. This may be due to the aggressive administration of periocular and oral steroids combined with scheduled anti-VEGF injections that were later transitioned into a treat and extend regimen.

Topics: Aged; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Antiviral Agents; Benzophenones; Bromobenzenes; Cataract Extraction; Drug Combinations; Endophthalmitis; Eye Infections, Bacterial; Female; Fluorescein Angiography; Glucocorticoids; Humans; Prednisone; Retinal Hemorrhage; Retinal Vasculitis; Tomography, Optical Coherence; Valacyclovir; Vancomycin

To report a case of unilateral varicella zoster virus (VZV) retinal vasculitis aspect in an immunocompetent child without systemic infection. Clinically, no signs of retinal necrosis or frosted branch vasculitis were present. This is an observational case report. Quantitative PCR was performed on the aqueous humor (AH) using primers specific for herpes virus (cytomegalovirus, Epstein-Barr virus, herpes simplex virus 1-2, and VZV). The patient was treated with intravenous acyclovir, intravitreous ganciclovir, and oral valacyclovir. A positive quantitative PCR result was found for VZV DNA (1.72 x 10(6) viral copies/ml) in the AH. After 6 months, PCR of the AH was negative. Herpes viruses are involved in the pathogenesis of isolated retinal vasculitis. This case demonstrates that quantitative PCR is useful to detect viral DNA in AH and to monitor the viral activity and the therapeutic response.

Topics: Acyclovir; Antiviral Agents; Aqueous Humor; Child; DNA, Viral; Drug Administration Routes; Eye Infections, Viral; Female; Ganciclovir; Herpesvirus 3, Human; Humans; Photophobia; Polymerase Chain Reaction; Retinal Vasculitis; Treatment Outcome; Valacyclovir; Valine; Vision, Low