Purpose: To report the use of combined intravitreal triamcinolone and foscarnet therapy in a patient with active acute retinal necrosis.
Methods: Retrospective case report. A 40-year-old white woman with a history of ulcerative proctitis, intolerant to oral steroids, developed an aggressive case of acute retinal necrosis complicated by severe optic nerve edema resulting in 20/200 vision.
Results: Intravitreal foscarnet provided an initial improvement of the vitritis and retinitis; however, optic nerve edema and 20/200 vision persisted. After 2 weeks, intravitreal triamcinolone was combined with the foscarnet dose. Four days later, the optic nerve edema had resolved, the vision returned to 20/40, and the herpetic infection remained controlled. Eight months later, the patient had not experienced a retinal detachment, and acuity was 20/20. Oral steroids are an accepted adjunct to antiviral therapy in acute retinal necrosis; however, combined intravitreal steroid and antiviral therapy has not been previously reported. After combined intravitreal therapy was attempted, the patient experienced a rapid resolution of symptoms without exacerbating her retinitis.
Conclusion: In select patients, combined intravitreal triamcinolone and foscarnet may be effective in treating acute retinal necrosis and its inflammatory sequelae.