Search

Purpose: To report the case of a 75-year-old man with diabetes who developed cytomegalovirus (CMV) retinitis after intravitreous injection of triamcinolone acetonide (IVTA)., Design: Observational case report., Methods: Review of medical records., Results: A 75-year-old man with diabetic macular edema developed arcuate retinal whitening after IVTA. A presumptive diagnosis of viral retinitis was made, and a vitrectomy was performed. Polymerase chain reaction of the vitreous was positive for CMV DNA. An infectious disease consultant found no signs of systemic CMV infection, and laboratory examination revealed that the patient was HIV negative. The patient responded well to intravitreal ganciclovir and oral valganciclovir, but when therapy was discontinued, the retinitis recurred and CMV DNA was again detected in the vitreous. The retinitis once again responded to antiviral therapy., Conclusions: CMV retinitis can occur after local immunosuppression with IVTA. Clinicians should be aware of this rare complication of IVTA.

Objective: To determine the prevalance, associated biometric factors, and rate of disappearance of neonatal retinal hemorrhage., Design: Cross-sectional and natural history study., Methods: Healthy newborns (n = 149) at an urban hospital were examined using indirect ophthalmoscopy within 30 hours of birth. Newborns with retinal hemorrhage were reexamined biweekly until hemorrhage resolved., Main Outcome Measures: Neonatal and maternal biometric factors, and incidence and rate of resolution of retinal hemorrhage., Results: Intraretinal hemorrhage was present in 34% of newborns and varied from a single dot hemorrhage in one eye to bilateral widespread hemorrhages, occasionally with white centers. The incidence of hemorrhage was higher for vacuum-assisted (75%) than for spontaneous vaginal deliveries (33%) and was least for infants delivered by cesarean section (7%). The mean maternal age was greater for infants with retinal hemorrhage. By 2 weeks after birth, retinal hemorrhage resolved in 86% of eyes, and at 4 weeks no intraretinal hemorrhage was detected, although a single subretinal hemorrhage persisted until 6 weeks after birth., Conclusions: Intraretinal hemorrhages are common in the immediate postnatal period and resolve by 1 month of age. Retinal hemorrhage in infants older than 1 month should heighten suspicion that the hemorrhage is associated with factors other than birth.

In the repair of retinal tears and detachments, the vitreous humor is often completely replaced with a temporary mixture of gases, one of which is not normally found in the bloodstream. The resulting bubble can then support the healing retina. There is diffusion of gases, however, from the bubble into the bloodstream and vice versa. This alters the intraocular pressure, with possible adverse consequences, as the intraocular pressure must be maintained within a certain range for the procedure to be successful. A simple model has been developed to predict the evolution of intraocular pressure over time, given a certain initial mixture of injected gases. This model could be useful in determining what mixture to use to support effectively and safely a healing retina.