RESUMO
PURPOSE: To report a case of bilateral cytomegalovirus (CMV) retinitis in an otherwise healthy infant. METHODS: A four-month-old, healthy, male infant was evaluated for visual inattention. RESULTS: This full-term infant with a normal birth weight and an uneventful gestational period was referred with symptoms of visual inattention, fever, and agitation one week prior to admission. Ocular involvements were detected in the form of bilateral pan uveitis with diffuse bilateral retinitis and vasculitis with hemorrhage in the peripheral retina and posterior pole. CMV DNA was detected in the patient's ocular sample and cerebrospinal fluid by polymerase chain reaction (PCR). He was treated with intravitreal and systemic ganciclovir. Unfortunately, the infant died because of CMV encephalitis. Therefore, bilateral CMV retinitis (CMVR), which was probably transmitted from the mother, was diagnosed in this immunocompetent infant. CONCLUSIONS: The present case highlights the possibility of CMVR in immunocompetent infant associated with systemic CMV infection, even during the postnatal period. Therefore, a high index of clinical suspicion and prompt treatment may be life-saving in similar cases.
RESUMO
PURPOSE: To evaluate the effects of intravitreal injection of recombinant tissue plasminogen activator (TPA) for the treatment of refractory diabetic macular edema. METHODS: A total of 27 patients with refractory diabetic macular edema with no evidence of posterior vitreous detachment were randomly assigned into follow-up (F/U) or TPA treatment groups. To control for the effects of intravitreal injection, an additional 14 patients with diabetic macular edema who were candidates for first-time intravitreal bevacizumab injection were enrolled as the IVB group. For the TPA and IVB groups, 25 µg of TPA or 1.25 mg of bevacizumab, respectively, were intravitreally injected. Fundoscopy, optical coherence tomography, and B-scan ultrasonography were performed at 1 week, 1 month, and 3 months after initiation of the study. RESULTS: The incidence of posterior vitreous detachment in fundoscopy over the follow-up period was 69.2% in the TPA group, which was significantly higher than that of the F/U and IVB groups (P = 0.001). Best-corrected visual acuity and changes in macular thickness did not significantly differ between the TPA and F/U groups over the 3-month period. CONCLUSION: Intravitreal TPA injection induces posterior vitreous detachment in patients with diabetic macular edema refractory to standard treatment but has no effect on macular thickness or best-corrected visual acuity within 3 months.
