Bilateral acute retinal necrosis after bilateral cataract surgery in an immunocompromised patient: a case report

Int Ophthalmol. 2018 Jun;38(3):1329-1332. doi: 10.1007/s10792-017-0555-x. Epub 2017 May 23.

Abstract

Purpose: To report a case of bilateral varicella zoster virus (VZV)-associated acute retinal necrosis (ARN) occurring after both eyes sequential cataract surgery in an elderly immunocompromised patient.

Methods: Medical records and investigation results of the patient were reviewed.

Results: Patient experienced floaters and blurring of vision in both eyes 4 weeks after her second uncomplicated cataract surgery. Clinical signs of granulomatous keratic precipitates, prominent vitritis, retinitis and vascular thrombosis were noted in both eyes. Aqueous samples from both eyes were positive for VZV. Disease was treated with intravitreal foscarnet bilaterally and 10 days of systemic intravenous acyclovir (10 mg/kg) followed by oral valaciclovir 1 g three times daily. Final visual acuity at 4 months after initial presentation was 20/60 in both eyes with no retinal detachment noted.

Conclusions: Cataract surgery may have been the trigger for bilateral VZV-associated ARN. Immunocompromised patients can develop ARN and require close observation after cataract surgery. This is, to our knowledge, the first report of bilateral ARN following routine cataract surgery.

Keywords: Acute retinal necrosis; Cataract surgery; Immunocompromised; Varicella zoster virus.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antibodies, Viral / immunology
  • Cataract Extraction / adverse effects*
  • Eye Infections, Viral / etiology*
  • Eye Infections, Viral / virology
  • Female
  • Herpesvirus 3, Human / immunology*
  • Humans
  • Immunocompromised Host*
  • Retinal Necrosis Syndrome, Acute / etiology*
  • Retinal Necrosis Syndrome, Acute / immunology
  • Retinal Necrosis Syndrome, Acute / virology
  • Surgical Wound Infection / etiology*
  • Surgical Wound Infection / immunology
  • Surgical Wound Infection / virology
  • Varicella Zoster Virus Infection / diagnosis
  • Varicella Zoster Virus Infection / etiology*
  • Varicella Zoster Virus Infection / virology
  • Visual Acuity

Substances

  • Antibodies, Viral