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Article: Repeated intraocular crystallization of ganciclovir in one eye after bilateral intravitreal injections: a case report

TitleRepeated intraocular crystallization of ganciclovir in one eye after bilateral intravitreal injections: a case report
Authors
KeywordsCMV
Crystallization
Cytomegalovirus retinitis
Ganciclovir
Intraocular
Issue Date2018
PublisherBioMed Central Ltd. The Journal's web site is located at http://www.biomedcentral.com/bmcophthalmol/
Citation
BMC Ophthalmology, 2018, v. 18 n. 1, p. article no. 36 How to Cite?
AbstractBACKGROUND: Cytomegalovirus (CMV) retinitis is an opportunistic infection that primarily affects immunocompromised individuals. Intravitreal ganciclovir injection monotherapy or in combination with systemic anti-CMV therapy are effective treatments for CMV retinitis. Crystallization of ganciclovir after intravitreal injection is extremely rare. Only two cases had been reported in literature. Crystallization in only one eye after bilateral injections had not been reported before. We hereby report a case of intraocular ganciclovir crystallization in one eye after bilateral intravitreal injections, and repeated crystallization in the same eye after repeated injections. CASE PRESENTATION: A 79-year-old patient had bilateral cytomegalovirus retinitis and received bilateral intravitreal ganciclovir injections of 2.5 mg in 0.05 ml sterile water. Fundus examination after injection showed formation of needle-shaped, golden-yellow crystals in the vitreous of right eye but not in left eye. The crystals dissolved spontaneously. Repeated bilateral intravitreal ganciclovir injections 4 days later resulted in repeated crystallization of ganciclovir in right eye but not in left eye. The crystals dissolved spontaneously and completely after 5 minutes. Visual acuity remained unchanged and intraocular pressure was normal. CONCLUSIONS: Intraocular ganciclovir crystallization could occur after intravitreal injections. It is important to perform fundus examination after injection. The crystals may dissolve rapidly and vitrectomy may not be necessary. Our case suggested intraocular ganciclovir crystallization is an idiosyncratic phenomenon, subjects to distinctive intraocular environment which could be different between two eyes of the same patient. The susceptible intraocular environment could be persistent leading to repeated crystallization.
Persistent Identifierhttp://hdl.handle.net/10722/277424
ISSN
2017 Impact Factor: 1.77
2015 SCImago Journal Rankings: 0.938
PubMed Central ID

 

DC FieldValueLanguage
dc.contributor.authorIu, LPL-
dc.contributor.authorFan, MCY-
dc.contributor.authorLam, WC-
dc.contributor.authorWong, IYH-
dc.date.accessioned2019-09-20T08:50:49Z-
dc.date.available2019-09-20T08:50:49Z-
dc.date.issued2018-
dc.identifier.citationBMC Ophthalmology, 2018, v. 18 n. 1, p. article no. 36-
dc.identifier.issn1471-2415-
dc.identifier.urihttp://hdl.handle.net/10722/277424-
dc.description.abstractBACKGROUND: Cytomegalovirus (CMV) retinitis is an opportunistic infection that primarily affects immunocompromised individuals. Intravitreal ganciclovir injection monotherapy or in combination with systemic anti-CMV therapy are effective treatments for CMV retinitis. Crystallization of ganciclovir after intravitreal injection is extremely rare. Only two cases had been reported in literature. Crystallization in only one eye after bilateral injections had not been reported before. We hereby report a case of intraocular ganciclovir crystallization in one eye after bilateral intravitreal injections, and repeated crystallization in the same eye after repeated injections. CASE PRESENTATION: A 79-year-old patient had bilateral cytomegalovirus retinitis and received bilateral intravitreal ganciclovir injections of 2.5 mg in 0.05 ml sterile water. Fundus examination after injection showed formation of needle-shaped, golden-yellow crystals in the vitreous of right eye but not in left eye. The crystals dissolved spontaneously. Repeated bilateral intravitreal ganciclovir injections 4 days later resulted in repeated crystallization of ganciclovir in right eye but not in left eye. The crystals dissolved spontaneously and completely after 5 minutes. Visual acuity remained unchanged and intraocular pressure was normal. CONCLUSIONS: Intraocular ganciclovir crystallization could occur after intravitreal injections. It is important to perform fundus examination after injection. The crystals may dissolve rapidly and vitrectomy may not be necessary. Our case suggested intraocular ganciclovir crystallization is an idiosyncratic phenomenon, subjects to distinctive intraocular environment which could be different between two eyes of the same patient. The susceptible intraocular environment could be persistent leading to repeated crystallization.-
dc.languageeng-
dc.publisherBioMed Central Ltd. The Journal's web site is located at http://www.biomedcentral.com/bmcophthalmol/-
dc.relation.ispartofBMC Ophthalmology-
dc.rightsBMC Ophthalmology. Copyright © BioMed Central Ltd.-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectCMV-
dc.subjectCrystallization-
dc.subjectCytomegalovirus retinitis-
dc.subjectGanciclovir-
dc.subjectIntraocular-
dc.titleRepeated intraocular crystallization of ganciclovir in one eye after bilateral intravitreal injections: a case report-
dc.typeArticle-
dc.identifier.emailIu, LPL: lawipl@hku.hk-
dc.identifier.emailFan, MCY: cymicfan@hku.hk-
dc.identifier.emailLam, WC: waichlam@hku.hk-
dc.identifier.emailWong, IYH: wongyhi@hku.hk-
dc.identifier.authorityLam, WC=rp02162-
dc.identifier.authorityWong, IYH=rp01467-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1186/s12886-018-0703-8-
dc.identifier.pmid29426296-
dc.identifier.pmcidPMC5807747-
dc.identifier.scopuseid_2-s2.0-85041863851-
dc.identifier.hkuros305712-
dc.identifier.volume18-
dc.identifier.issue1-
dc.identifier.spagearticle no. 36-
dc.identifier.epagearticle no. 36-
dc.publisher.placeUnited Kingdom-

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