| 본문 : Purpose
To report a case of inadvertent injection of high dosage of ganciclovir which resulted in toxic crystalline retinopathy characterized with retinal intravascular crystal formation, retinal capillary obstruction and optic atrophy, impairing the patient’s vision permanently.
Case report
A 49-year-old man reported decreased central vision in his left eye. We diagnosed his illness as cytomegalovirus (CMV) retinitis based on the results of a standard funduscopic examination and the presence of viral antigen in peripheral blood. He was treated with intravenous ganciclovir, oral prednisolone and an intravitreal injection of ganciclovir (2.5 mg/0.05 mL). After two and half years from initial therapy, two times of intravitreal ganciclovir injection of 2 mg/0.04 mL were performed as scheduled. On the third injection, about 8 times higher dosage of 15 mg/0.3 mL of ganciclovir was injected by mistake. Just after the procedure, the patient reported sudden decrease of vision to no light perception, and the intraocular pressure was measured 30 mmHg OS. Immediate fundoscopic examination revealed diffuse multiple crystallization on macula in his left eye, and Fluorescein angiography (FA) demonstrated severe retinal microvascular leakage and enlarged nonperfusion area. A day after the injection, visual acuity of his left eye was still light perception. Multiple hemorrhages were seen on macula and subsequent OCT showed macular edema and diffuse retinal exudation. Two weeks after the event, retinal hemorrhages, crystalline deposits and edema in the macula disappeared, but the disc grew pale and atrophic. The patient’s vision was not improved for three years of follow up.
Conclusion
Special caution on the drug concentration and dosage is mandatory before and during the intravitreal injection of ganciclovir.
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