Acute retinal necrosis (ARN) is a panuveitis syndrome that may lead to severe complications such as cystoid macular edema (CME). There is no consensus about the best treatment. We report one case of CME secondary to ARN managed with intravitreal aflibercept.
A 41-year-old woman with a history of successfully treated varicella-zoster virus-associated ARN developed an epiretinal membrane (ERM) and underwent pars plana vitrectomy, ERM removal, inner limiting membrane peel, and lensectomy. After surgery, the retinal architecture improved and the visual acuity returned to 20/20. Six months later, she developed nontractional CME, which was treated monthly with triple-dose intravitreal aflibercept (2 mg). She gained 3 lines of vision and CME resolution was achieved.
Cystoid macular edema is a late complication of ARN that may affect vision. Some off-label therapies have been reported to be useful in CME secondary to ARN, including pegaptanib and interferon-α-2. Since interferon-α-2a is not currently available for ophthalmic use in Spain, aflibercept was the first choice. This soluble protein blocks the placental growth factor and all isoforms of vascular endothelial growth factor (VEGF); its half-life is prolonged and its affinity to VEGF-A is more than 100-fold greater than bevacizumab, pegaptanib, or ranibizumab. After each injection, macular thickness decreased consistently and visual acuity improved 3 lines after the treatment.
Intravitreal aflibercept is effective in the management of acute nontractional CME secondary to ARN.
Post author correction
Article Type: CASE REPORT
Article Subject: Retina MED
AuthorsLeticia Ortega-Evangelio, Javier Navarrete-Sanchis, Basil K. Williams, Juan Miguel Tomás-Torrent
- • Accepted on 01/09/2017
- • Available online on 14/09/2017
This article is available as full text PDF.
- Ortega-Evangelio, Leticia [PubMed] [Google Scholar] 1, * Corresponding Author (email@example.com)
- Navarrete-Sanchis, Javier [PubMed] [Google Scholar] 2
- Williams, Basil K. [PubMed] [Google Scholar] 3
- Tomás-Torrent, Juan Miguel [PubMed] [Google Scholar] 2
Department of Ophthalmology, Quijada Medicina Ocular, Valencia - Spain
Department of Ophthalmology, The Ribera Hospital, Alzira - Spain
Bascom Palmer Eye Institute, Miami, FL - USA