Aflibercept/ranibizumab/dexamethasone

Abstract

Cytomegalovirus-retinitis and lack of efficacy: case report An 80-year-old man developed Cytomegalovirus (CMV) retinitis during treatment with dexamethasone. Additionally, he exhibited lack of efficacy while being treated with ranibizumab and aflibercept for neovascular age-related macular degeneration [dosages not stated]. The man presented with a 2-week history of left eye floaters and irritation 10 weeks following dexamethasone intravitreal implant [Ozurdex] injection for neovascular age-related macular degeneration (AMD). Initially, he had received intravitreal ranibizumab and aflibercept for AMD along with photodynamic therapy for 8 years; however, the choroidal neovascularisation (CNV) had become refractory to these therapies. Although, an improvement was noted with intravitreal dexamethasone injection. He had received six injections over the preceding 2 years. He also had relevant medical histories of asthma, prostate cancer and residual mild renal impairment. At the time of presentation, he underwent a best corrected visual acuity test in his left eye, which was decreased. His intraocular pressure in the left eye was 13mm Hg. A mild ciliary flush, fine keratic precipitates, 3+ cells in the anterior chamber, a well-positioned posterior chamber intraocular lens, moderate vitritis and white retinitis, which was associated with peripheral scattered retinal haemorrhages in the nasal and superior quadrants, posterior pole and inferior to the inferior retinal vascular arcade was revealed in the left eye examination, whereas viral retinitis the right eye examination was unremarkable. Finally, he was provisionally diagnosed with viral rhinitis. After that, he underwent an urgent vitreous cavity pars plana biopsy, which was positive for CMV on polymerase chain reaction. His CMV serology showed a positive IgG result and a negative IgM result for CMV. The man was immediately treated with valganciclovir and foscarnet. Eventually, after 2 months of valganciclovir treatment, his vision improved, and his CMV retinitis resolved.