Rapid regression of cystoid macular edema associated with cytomegalovirus retinitis in adult acute myeloid leukemia by intravitreal methotrexate combined with oral valganciclovir: A case report with comparison of binocular outcome

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• 作者：Evelyn Jou-Chen Huang^a ; ^b ; ^c ; ^{roro691213@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Chih-Ping Wang^a ; ^b ; Chien-Hsiung Lai^a ; ^b ; ^c ; Chih-Chien Chen^d ; Chien-Neng Kuo^a ; ^b
• 关键词：cystoid macular edema ; cytomegalovirus retinitis ; hematopoietic stem cell transplantation ; methotrexate ; valganciclovir
• 刊名：Taiwan Journal of Ophthalmology
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：6
• 期：3
• 页码：145-149
• 全文大小：855 K

文摘

Cytomegalovirus (CMV) retinitis is a late complication of organ and hematopoietic stem cell transplant, the risk of which depends on the degree of immunosuppression. With the institution of preemptive ganciclovir therapy early after transplant, most patients survive episodes of life-threatening CMV infection during the early months (usually the first 3 months) after transplant and hence late onset of CMV disease, such as CMV retinitis, is being recognized more frequently. Direct involvement of the macula or optic head remains the leading cause of visual loss in patients with CMV retinitis, but there are few studies investigating the management of this condition.

Herein, we present the case of 28-year-old man who had acute myeloid leukemia and developed CMV retinitis with bilateral cystoid macular edema and optic swelling in the right eye 6 months after bone marrow transplant. He received treatment with intravitreal methotrexate in the right eye in combination with oral valganciclovir. Visual acuity improved 1 month after four weekly injections of intravitreal methotrexate 400 μg/0.1 mL. Resolved disc swelling and regression of macular edema were also observed. By comparing binocular outcome, we present our findings and discuss the possible efficacy and safety of this treatment with respect to regression of anatomical damage and improvement in visual acuity.