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O. M. Krajnyk, D. B. Roth, J. Prenner; The Incidence of Noninfectious Endophthalmitis After Intravitreal Preservative-Free Triamcinolonce Acetonide. Invest. Ophthalmol. Vis. Sci. 2007;48(13):247.
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The use of off-label intravitreal trimacinolone acetonide (IVTA) has raised a concern regarding noninfectious endophthalmitis and inflammatory reactions associated with the drug. We sought to determine whether the use of preservative-free triamcinolone acetonide for intravitreal injection would reduce the incidence of this form of endophthalmitis.
After extensive experience with the use of KENALOG®-40 for intravitreal injection, we switched to the exclusive use of preservative-free triamcinolone acetonide, obtained from a commercial compounding pharmacy. Single-dose vials were obtained and no manipulation of the drug, removal of supernatant, filtering or washing was performed. We reviewed the medical records of all patients receiving preservative-free IVTA from July 1, 2006 through Nov 14, 2006. Demographic information and details of post-injection inflammation or endophthalmitis were collected.
326 patients were identified who received a total of 380 IVTA injections. Nine eyes (2.3%) of nine patients (2.8%) were identified that experienced an inflammatory reaction after preservative-free IVTA. Endophthalmitis with obscuration of all fundus details was observed in 6 eyes and moderate inflammation was noted in 3 eyes. An inflammatory hypopyon distinct from triamcinolone particles was seen in 7 eyes. Seven eyes were pseuophakic and 2 were phakic. In pseudophakic eyes, the capsule was intact in 4 eyes. The indication for IVTA was post-operative CME in 66.7% of eyes experiencing noninfectious endophthalmitis. Seven of the nine cases resolved spontaneously without intervention. Two of the nine cases were cultured and received intraocular antibiotics due to a concern for infectious endophthalmitis. Both of these cultures had no growth.
Preservative-free triamcinolone acetonide does not seem to reduce the incidence of post-injection inflammatory reactions. Post-IVTA noninfectious endophthalmitis appears to be more common in eyes being treated for post-operative cystoid macular edema.
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