LETTER TO THE EDITOR Re: Intravitreal triamcinolone acetonide as an look for severe vitritis, retinal detachment, and retinitis or occlusive vasculitis in the posterior pole to decide whether adjuvant in the management of acute to use a steroid or not.3 retinal necrosis Therefore, the use of steroids in ARN deserves more Dear Editor, We have read with interest the recent article “Intravitreal triamcinolone acetonide as an adjuvant in the management of acute retinal necrosis” by Choudhury et al.1 The authors conclude that intravitreal triamcinolone could be a useful adjunct to systemic steroids in the treatment of acute retinal necrosis (ARN). It is known that progressive outer retinal necrosis and ARN are necrotizing herpetic retinopathies characterized by mild to severe immune dysfunction. Another fact is that use of an exogenous and intravitreal corticosteroid might predispose to ARN via reactivation of viral replication.2,3 All the patients in the mentioned study were reported to be immunocompetent. As far as we know, there is no valuable knowledge about the use of steroids in ARN cases with immune dysfunction. So we would like to contribute to the authors’ conclusion that it is better to be cautious while using steroids in cases having risk factors such as diminished CD4þ T cell count, posttransplant period, or age older than 60 years. Furthermore, the physician must

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CAN J OPHTHALMOL — VOL. 49, NO. 5, OCTOBER 2014

attention, and choices should be revised for immunocompromised patients. Yours sincerely, Abdullah Ilhan, MD, Umit Yolcu, MD, Fatih C. Gundogan

Erzurum Maresal Cakmak Military Hospital Erzurum, Turkey REFERENCES

1. Choudhury H, Jindal A, Mithal K, Bawdekar AC, Pathengay A. Intravitreal triamcinolone acetonide as an adjuvant in the management of acute retinal necrosis. Can J Ophthalmol. 2014;49:279-82. 2. Guex-Crosier Y, Rochat C, Herbort CP. Necrotizing herpetic retinopathies: a spectrum of herpes virus-induced diseases determined by the immune state of the host. Ocul Immunol Inflamm. 1997;5: 259-65. 3. Wong RW, Jumper JM, McDonald HR, et al. Emerging concepts in the management of acute retinal necrosis. Br J Ophthalmol. 2013;97: 545-52. Can J Ophthalmol 2014;49:478 0008-4182/14/$-see front matter & 2014 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jcjo.2014.07.015

Re: Intravitreal triamcinolone acetonide as an adjuvant in the management of acute retinal necrosis.

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