# Neuroretinitis With Severe Macular Edema in Dual Infection: Challenges in Management

## TL;DR

A 49-year-old woman with neuroretinitis caused by two infections developed severe macular edema, which improved after treatment including an intravitreal injection.

## Contribution

This case highlights the effectiveness of intravitreal ranibizumab in managing severe macular edema in dual-infection neuroretinitis.

## Key findings

- The patient had neuroretinitis caused by Toxoplasma and Herpes Simplex Virus type 1.
- Intravitreal ranibizumab significantly reduced subretinal fluids in the patient.
- Persistent macular edema responded well to the combination of antiviral, antibiotic, and anti-VEGF treatments.

## Abstract

Neuroretinitis is a potentially vision-threatening condition distinguished by swelling of the optic disc followed by the emergence of a macular star pattern. The majority of these clinical observations are typically linked to infections caused by bacteria, parasites, or viruses. We report a case of dual infections in neuroretinitis complicated with severe macular edema.

A 49-year-old lady presented with sudden onset left eye blurring of vision of one-week duration. Visual acuity was 6/6 in the right eye and 6/60 in the left eye. There was a left positive relative afferent pupillary defect with impaired optic nerve functions. A fundoscopy of the left eye showed optic disc swelling with a macular star. The right optic disc was also swollen. Vasculitis changes were observed in both posterior poles. The ocular coherence tomography of the left eye revealed the existence of macular edema, subretinal fluids, and an epiretinal membrane that extended from the optic disc to the fovea. Serological examinations were positive for toxoplasma and herpes simplex virus type 1. The patient was started on oral azithromycin, oral acyclovir, and oral corticosteroids. Left macular edema persisted despite the treatment. The patient was given a trial of a single injection of intravitreal ranibizumab. A remarkable reduction of subretinal fluids was seen post-intravitreal injection and continuation of medications. Intravitreal ranibizumab has shown significant outcomes in neuroretinitis with severe macula edema.