title: Viral retinitis following intraocular or periocular corticosteroid administration: a case series and comprehensive review of the literature.
abstract: OBJECTIVE
  To describe viral retinitis following intravitreal and periocular corticosteroid administration.
  
  
  METHODS
  Retrospective case series and comprehensive literature review.
  
  
  RESULTS
  We analyzed 5 unreported and 25 previously published cases of viral retinitis following local corticosteroid administration. Causes of retinitis included 23 CMV (76.7%), 5 HSV (16.7%), and 1 each VZV and unspecified (3.3%). Two of 22 tested patients (9.1%) were HIV positive. Twenty-one of 30 (70.0%) cases followed one or more intravitreal injections of triamcinolone acetonide (TA), 4 (13.3%) after one or more posterior sub-Tenon injections of TA, 3 (10.0%) after placement of a 0.59-mg fluocinolone acetonide implant (Retisert), and 1 (3.3%) each after an anterior subconjunctival injection of TA (together with IVTA), an anterior chamber injection, and an anterior sub-Tenon injection. Mean time from most recent corticosteroid administration to development of retinitis was 4.2 months (median 3.8; range 0.25-13.0). Twelve patients (40.0%) had type II diabetes mellitus. Treatments used included systemic antiviral agents (26/30, 86.7%), intravitreal antiviral injections (20/30, 66.7%), and ganciclovir intravitreal implants (4/30, 13.3%).
  
  
  CONCLUSIONS
  Viral retinitis may develop or reactivate following intraocular or periocular corticosteroid administration. Average time to development of retinitis was 4 months, and CMV was the most frequently observed agent. Diabetes was a frequent co-morbidity and several patients with uveitis who developed retinitis were also receiving systemic immunosuppressive therapy.
authors.affiliation: Department of Ophthalmology, California Pacific Medical Center , San Francisco, California , USA .
authors.forename: Ako
authors.initials: A
authors.lastname: Takakura
authors.forename: Howard H
authors.initials: HH
authors.lastname: Tessler
authors.forename: Debra A
authors.initials: DA
authors.lastname: Goldstein
authors.forename: Yan
authors.initials: Y
authors.lastname: Guex-Crosier
authors.forename: Chi-Chao
authors.initials: CC
authors.lastname: Chan
authors.forename: Diane M
authors.initials: DM
authors.lastname: Brown
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Thorne
authors.forename: Robert
authors.initials: R
authors.lastname: Wang
authors.forename: Emmett T
authors.initials: ET
authors.lastname: Cunningham
mesh_terms: D000328:Adult; D000368:Aged; D015828:Eye Infections, Viral / Q000175:diagnosis / Q000209:etiology* / Q000821:virology; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D056965:Injections, Intraocular / Q000009:adverse effects; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D012173:Retinitis / Q000175:diagnosis / Q000209:etiology* / Q000821:virology; D014605:Uveitis / Q000188:drug therapy
chemical_list: D005938:Glucocorticoids
keywords: Acute retinal necrosis; corticosteroid; cytomegalovirus; herpes virus; injection; retinitis