Suspected Retinal Toxicity After Multiple Intravitreal Ganciclovir Injections in a Patient of CMV Retinitis

ABSTRACT

Purpose

Intravitreal Ganciclovir has been one of the treatments of choice for cytomegalovirus (CMV) retinitis and has been used extensively for its treatment since 1987. It has not been shown to have any major adverse effects. There are no reports on any retinal toxicity even after multiple, repeated injections. Herein, we report a rare case of retinal toxicity after multiple intravitreal injections in a patient of CMV retinitis.

Case Report

A 69-year-old one eyed male, who was on oral corticosteroids and systemic immunosuppression for Granulomatosis with Polyangiitis, presented with CMV retinitis in both eyes. His visual acuity was 20/60 in his right eye and no perception of light in his left eye. He was treated with multiple injections of intravitreal Ganciclovir in his right eye. The left eye was not treated since it had no vision potential. The right eye of the patient which had received multiple injections went on to developed a progressive diffuse atrophy of Retinal Pigment Epithelium (RPE). No such changes were noted in the left eye of the patient.

Conclusion and Importance

We present a case of progressive diffuse RPE atrophy as a result of toxicity of intravitreal ganciclovir injections. It is important to be aware of this rare potential toxicity of intravitreal Ganciclovir.

KEYWORDS:

• CMV retinitis
• ganciclovir
• immunosuppression
• retinal pigment atrophy
• toxicity

Acknowledgments

We thank the patient for granting permission to publish this information.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for images and the clinical information to be reported in the journal. The patient understands that her name and initials will not be published, and due effort will be made to conceal her identity, but anonymity cannot be guaranteed.

Authorship

All authors attest that they meet the current ICMJE criteria for authorship.MT was involved in patient care and drafting of the manuscript. RK and SVS were involved in review of literature, corrections and drafting the manuscript

Additional information

Funding

Support provided by Hyderabad Eye Research Foundation, Hyderabad, India. The funders had no role in the preparation, review or approval of the manuscript.