Admin_Adham
Jump to Key Points Several cases presented at the European Society of Retina Specialists (EURETINA) 2026 illustrate how herpesviruses may underlie eye conditions in ways that defy clinicians’ expectations.
Dexamethasone Implants: Hidden Risk for Infection?
Herpetic complications should be suspected following treatment with slow-release dexamethasone implants — even in patients who are immunocompetent, according to a pair of cases presented by Vicente Guijarro Ambel and colleagues at Hospital Universitario Virgen del Rocío in Seville, Spain.
The Cases
- Two patients with otherwise normal immune systems developed intraocular herpesvirus manifestations after receiving slow-release dexamethasone implants for conditions such as cystoid macular edema.
- A 67-year-old man presented with anterior uveitis, vitritis, and retinal necrosis 2 months after receiving an implant, with vitreous PCR positive for herpes simplex virus (HSV)-2. He responded favorably to treatment with intravenous acyclovir and intravitreal foscarnet.
- A 74-year-old woman developed acute anterior uveitis and eye pain 4 months post-implant, with aqueous humor PCR positive for HSV-1. The condition resolved with oral valaciclovir and topical corticosteroids.
Unusual Complication
“Current knowledge about the possible relationship between slow-release dexamethasone implant and the development of intraocular herpetic complications is still very limited,” the authors noted. “To date, there have been very few reports of intraocular complications caused by germs of the Herpesviridae family.”
Abstract title: “Intraocular Manifestations of Herpes Virus Following Slow-Release Dexamethasone Implant in Two Immunocompetent Patients”
- Slow-release dexamethasone implants may unmask intraocular herpesvirus in immunocompetent patients.
- Post-implant HSV cases: uveitis/vitritis/retinal necrosis; PCR confirmed HSV-2 or HSV-1.
- Antiviral therapy effective: IV acyclovir + intravitreal foscarnet; oral valaciclovir + topical steroids.
- Post-cataract inflammation: herpetic endophthalmitis should be in ddx, esp immunosuppressed.
- Recurrent uveitis during steroid tapering may signal HSV-triggered Behçet-spectrum disease.
Household Contact Key to Understanding Post-Surgery Complication
Clinicians should consider herpetic endophthalmitis in the differential diagnosis of inflammation after cataract surgery, especially in patients who are immunosuppressed or have a household history of herpesvirus, according to Raimunda Cristina Mendonca Freire de Pádua and colleagues from Brazil.
The Patient
- A 68-year-old woman with multiple myeloma on lenalidomide treatment developed acute visual decline 36 hours after uneventful phacoemulsification. She had diffuse facial redness and hyphema without elevation of intraocular pressure.
- Herpes zoster was not initially suspected but was determined to be the cause after clinicians learned a person in the patient’s home had been treated for the infection.
- Vitrectomy, intravitreal antibiotics, and systemic antiviral therapy controlled the infection and preserved ambulatory vision.
Their Take
“This case underscores the importance of a detailed anamnesis including household contacts, which enabled timely diagnostic suspicion,” the authors wrote.
Abstract title: “Acute Retinal Necrosis by Herpes Zoster After Phacoemulsification in an Immunosuppressed Monocular Patient: A Case Report”
Did HSV Trigger Autoimmune Disease?
Acute herpes infection may have triggered autoimmune ocular inflammation in a patient with HLA-B51-associated Behçet-spectrum disease. The overlap between infectious and immune-mediated uveitis can pose diagnostic and therapeutic challenges, reported Konstantinia Karamitsou and colleagues at General Hospital of Volos in Greece.
The Patient
- A 31-year-old man presented with uveitis and tested positive for HSV-1/2 immunoglobulin M; he initially improved with antiviral therapy but relapsed after tapering corticosteroids.
- The recurrent nature of the inflammation prompted a rheumatology consultation, and a comprehensive workup revealed HLA-B51 positivity, supporting a diagnosis of Behçet-spectrum disease.
- Initiation of systemic immunosuppressive therapy, including methotrexate and adalimumab, resulted in visual recovery and stabilization of inflammatory activity.
Keep in Mind
“When uveitis repeatedly returns during corticosteroid tapering, reconsider the diagnosis,” the authors suggested. “Look for the underlying immune-mediated disease — and follow the macula long after the inflammation has settled.”
Abstract title: “HSV-Triggered Recurrent Panuveitis, Vitritis, and Neuroretinitis in HLA-B51–Associated Behçet-Spectrum Disease: A Diagnostic Challenge”
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
