ABSTRACT
BACKGROUND: Varicella zoster reactivation is an increasingly recognised event following mRNA COVID-19 vaccination. In addition, various ocular inflammatory and infectious adverse events following COVID-19 vaccination have been described in the literature. This case report describes acute retinal necrosis (ARN) secondary to varicella zoster virus (VZV) reactivation following COVID-19 mRNA vaccination. CASE DESCRIPTION: A 42-year-old immunocompetent man developed left ARN 12 days following first dose of Pfizer BioNTech mRNA COVID-19 vaccination. Aqueous and vitreous tap polymerase chain reaction testing was positive for VZV. Good visual outcome was achieved with combination therapy, including intravitreal foscarnet, oral valaciclovir and prednisolone, topical dexamethasone and atropine, and barrier retinal laser. Second dose of the vaccine is planned under cover of high-dose oral valaciclovir therapy. CONCLUSION: This case illustrates the possible association between COVID-19 vaccination and potentially blinding VZV reactivation. Therefore, prompt ophthalmic assessment is recommended in patients with visual disturbance following COVID-19 vaccination.
Subject(s)
COVID-19 , Chickenpox , Herpes Zoster Ophthalmicus , Retinal Necrosis Syndrome, Acute , Male , Humans , Adult , Retinal Necrosis Syndrome, Acute/diagnosis , Retinal Necrosis Syndrome, Acute/drug therapy , Retinal Necrosis Syndrome, Acute/etiology , Antiviral Agents/therapeutic use , Valacyclovir/therapeutic use , Herpes Zoster Ophthalmicus/diagnosis , Herpes Zoster Ophthalmicus/drug therapy , Herpes Zoster Ophthalmicus/etiology , COVID-19 Vaccines/adverse effects , Chickenpox/drug therapy , COVID-19/diagnosis , Herpesvirus 3, Human/genetics , Vaccination/adverse effectsABSTRACT
The authors report a case of bilateral diffuse uveal melanocytic proliferation associated with transitional cell carcinoma of the bladder. A novel imaging finding on indocyanine green angiography of a "string of sausages" pattern in the large choroidal vessels is described. This occurs in areas of alternating retinal pigment epithelial hypertrophy and destruction, which is likely to be its cause. To the authors' knowledge, it has not been previously described. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:525-528.].
Subject(s)
Melanocytes/pathology , Paraneoplastic Syndromes, Ocular/pathology , Urinary Bladder Neoplasms/complications , Uveal Diseases/pathology , Aged , Humans , MaleABSTRACT
PURPOSE: To report a case of sudden loss of vision after intravitreal triamcinolone for the management of cystoid macular edema secondary to a central retinal vein occlusion with subsequent development of nonarteritic anterior ischemic optic neuropathy. METHOD: Retrospective case report. CONCLUSION: The pathophysiology of nonarteritic anterior ischemic optic neuropathy (NAION) still remains controversial. Our report does not allow any conclusion about a direct causal relationship, however we postulate a contributory role of intrvitreal triamcinolone in the development of NAION in our patient.
Subject(s)
Fundus Oculi , Retinal Diseases/pathology , Amino Acid Substitution , Choroid/pathology , Choroid/physiopathology , Choroidal Neovascularization/genetics , Choroidal Neovascularization/pathology , Choroidal Neovascularization/physiopathology , Female , Fluorescein Angiography , Humans , Middle Aged , Pedigree , Retinal Diseases/genetics , Retinal Diseases/physiopathology , Retinal Pigment Epithelium/pathology , Retinal Pigment Epithelium/physiopathology , Tissue Inhibitor of Metalloproteinase-3/genetics , Vision, Low , Visual AcuityABSTRACT
PURPOSE: Bevacizumab is an inhibitor of vascular endothelial growth factor widely used as an "off-label" treatment of neovascular age-related macular degeneration (AMD), despite the lack of clinical trial data on efficacy or safety of this drug. We describe acute intraocular inflammation after intravitreous injection of bevacizumab for the treatment of neovascular AMD. DESIGN: A retrospective case series. PARTICIPANTS: Patients with neovascular AMD treated with intravitreous injection of bevacizumab from clinical practices in 2 states (Victoria and South Australia) in Australia. METHODS: We retrospectively reviewed cases of acute intraocular inflammation after intravitreous injection of bevacizumab for the treatment of neovascular AMD. MAIN OUTCOME MEASURES: The detection and description of inflammation in a large cohort of patients. RESULTS: There were 14 cases (11 women and 3 men), from a total of 1278 injections given. The mean age of patients was 83.7 years (range, 74-98). The majority had a prior injection of bevacizumab, with a mean number of injections of 2.7 (range, 1-6). Most patients presented within 24 hours of intravitreous injection, with rapid reduction in vision, but minimal discomfort. There were associated signs of ocular inflammation in the anterior and posterior segments of the eye. Visual acuity at presentation was substantially reduced compared with the preinjection acuity, although the vision rapidly improved with treatment over a period of 7-25 days toward preinjection visual acuity. CONCLUSIONS: Intravitreous injection of bevacizumab for the treatment of neovascular AMD may be associated with acute intraocular inflammation. Differentiation from infectious endophthalmitis is important for appropriate management of this condition.
Subject(s)
Angiogenesis Inhibitors/adverse effects , Antibodies, Monoclonal/adverse effects , Choroidal Neovascularization/drug therapy , Endophthalmitis/chemically induced , Macular Degeneration/drug therapy , Acute Disease , Aged , Aged, 80 and over , Antibodies, Monoclonal, Humanized , Bevacizumab , Endophthalmitis/diagnosis , Female , Humans , Injections , Male , Retrospective Studies , Vascular Endothelial Growth Factor A , Visual Acuity/drug effects , Vitreous BodyABSTRACT
Biologics are a new class of drugs that comprise recombinant cytokines and monoclonal antibodies directed against selected cell-surface markers. They include the tumor necrosis factor-alpha inhibitors infliximab, etanercept, and adalimumab; the antilymphocyte drugs rituximab and alemtuzumab; the interleukin-2 receptor blocker daclizumab; and recombinant interferon-alpha. This article reviews the rationale and current evidence for their use in uveitis, scleritis, and orbital inflammation.
Subject(s)
Anti-Inflammatory Agents/therapeutic use , Antibodies, Monoclonal/therapeutic use , Biological Products/therapeutic use , Eye Diseases/drug therapy , Inflammation/drug therapy , Scleritis/drug therapy , Uveitis/drug therapy , Antibodies, Monoclonal/immunology , Cytokines/immunology , Cytokines/metabolism , Eye Diseases/immunology , Humans , Inflammation/immunology , Inflammation/metabolism , Interferon-alpha/immunology , Interferon-alpha/therapeutic use , Receptors, Cytokine/immunology , Receptors, Cytokine/metabolism , Recombinant Fusion Proteins/therapeutic use , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Tumor Necrosis Factor-alpha/immunology , Tumor Necrosis Factor-alpha/metabolismABSTRACT
PURPOSE: To report an occurrence of wound leak from the injection site after intravitreal injection of bevacizumab. A possible underlying etiology is discussed. METHODS: A single injection of bevacizumab was given for treatment of choroidal neovascularization complicating previous choroidal rupture. RESULTS: A reduction in vision and hypotony were noted 1 day after injection. With conservative management, there was spontaneous resolution of the wound leak. CONCLUSION: The risk of wound leak after intravitreal injection may be higher for younger patients and those who have undergone vitrectomy. All patients and clinicians, however, should be alert to vision decline after injection, and prompt evaluation should be performed to ascertain the cause. For patients with persistent wound leak, surgical intervention may be required.
