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유리체강내 포스카넷 주입술을 이용한 거대세포바이러스 망막염 치료 2예

Two Cases of Intravitreal Foscarnet Injection for Cytomegalovirus Retinitis

검안 및 콘택트렌즈학회지 2020년 19권 3호 p.82 ~ 86
윤영채, 최승용, 김미희,
소속 상세정보
윤영채 ( Yoon Young-Chae ) - Catholic University College of Medicine Yeouido St. Mary’s Hospital Department of Ophthalmology
최승용 ( Choi Seung-Yong ) - Catholic University College of Medicine Yeouido St. Mary’s Hospital Department of Ophthalmology
김미희 ( Kim Min-Hee ) - Catholic University College of Medicine Yeouido St. Mary’s Hospital Department of Ophthalmology

Abstract


Purpose: To report 2 cases of cytomegalovirus (CMV) retinitis treated with intravitreal foscarnet injection.

Case summary: (Case 1) A 64-year-old female with acute myeloid leukemia was consulted for ophthalmologic evaluation because of elevated CMV real-time quantitative polymerase chain reaction (RQ-PCR) on her blood. Fundoscopic examination revealed whitish inflitrative lesions at upper-temporal periphery with vitreous opacities on her right eye. We suspected CMV retinitis and performed 4 times of intravitreal ganciclovir injections on her right eye and intravenous ganciclovir injection. After that, whitish infiltrations and vitreous opacities diminished. However, 10 weeks after the initial visit, whitish infiltrations recurred on her both eyes. She already had ganciclovir tolerance and her creatinine clearance also decreased, so that we couldn’t do intravenous foscarnet injection. Alternatively, we did intravitreal foscarnet injection on her both eyes. After the injections, whitish lesions and cytomegalovirs RQ-PCR in anterior chamber was decreased and the visual acuity was increased. (Case 2) A 60-year-old male, who was hospitalized for chemotherapy for diagnoses of diffuse large B cell lymphoma, was consulted for decreased visual acuity of his left eye for 1 month. Fundoscopic examination revealed vitreous opacities and whitish infiltrative lesions around optic disc and uppertemporal periphery of retina on his left eye. We suspected CMV retinitis, and injected intravitreal & intravenous ganciclovir. 2 weeks later, we found another infiltrative lesions at his right eye and also, the CMV RQ-PCR in left eye was increased. So, we decided to do intravitreal foscarnet injections on his both eyes. After the injections, the whitish lesions and CMV RQ-PCR in anterior chamber were decreased.

Conclusions: Intravitreal foscarnet injection can be considered in patients with CMV retinitis when it progresses despite of systemic antiviral treatment, when systemic antiviral agents are difficult to use, and when it progresses or recurs after intravitreal ganciclovir injection.

키워드

Cytomegalovirus retinitis; Foscarnet; Ganciclovir; Intravitreal injection

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