Chun Yue Mak1, Helena Pui-Yee Sin1, Mary Ho1, Vesta Cheuk-Ki Chan1, Alvin Lerrmann Young1,2, Marten Erik Brelen3,4. 1. Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, 1/F, Eye Centre, 30-32 NganShing Street, Shatin, New Territories, Hong Kong. 2. Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, 4/F Hong Kong Eye Hospital, 147K Argyle Street, Kowloon, Hong Kong. 3. Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, 1/F, Eye Centre, 30-32 NganShing Street, Shatin, New Territories, Hong Kong. marten.brelen@cuhk.edu.hk. 4. Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, 4/F Hong Kong Eye Hospital, 147K Argyle Street, Kowloon, Hong Kong. marten.brelen@cuhk.edu.hk.
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.
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.