Use of intravitreal triamcinolone for the treatment of optic nerve edema in a patient with acute retinal necrosis: case report.
OBJECTIVE
To report the use of combined intravitreal triamcinolone and foscarnet therapy in a patient with active acute retinal necrosis.


METHODS
Retrospective case report. A 40-year-old white woman with a history of ulcerative proctitis, intolerant to oral steroids, developed an aggressive case of acute retinal necrosis complicated by severe optic nerve edema resulting in 20/200 vision.


RESULTS
Intravitreal foscarnet provided an initial improvement of the vitritis and retinitis; however, optic nerve edema and 20/200 vision persisted. After 2 weeks, intravitreal triamcinolone was combined with the foscarnet dose. Four days later, the optic nerve edema had resolved, the vision returned to 20/40, and the herpetic infection remained controlled. Eight months later, the patient had not experienced a retinal detachment, and acuity was 20/20. Oral steroids are an accepted adjunct to antiviral therapy in acute retinal necrosis; however, combined intravitreal steroid and antiviral therapy has not been previously reported. After combined intravitreal therapy was attempted, the patient experienced a rapid resolution of symptoms without exacerbating her retinitis.


CONCLUSIONS
In select patients, combined intravitreal triamcinolone and foscarnet may be effective in treating acute retinal necrosis and its inflammatory sequelae.
Ophthalmology Service, Department of Surgery, Madigan Army Medical Center, Tacoma, Washington.
Patrick D
PD
Munson
Mark L
ML
Nelson
Courtney
C
Crawford
Bruce A
BA
Rivers
Paula E
PE
Young
D000328:Adult; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D058449:Intravitreal Injections; D010211:Papilledema / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D015882:Retinal Necrosis Syndrome, Acute / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D014792:Visual Acuity
D005938:Glucocorticoids; D014222:Triamcinolone Acetonide