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H. Grabe, E. F. Hall, S. J. Saxe; Incidence of Sterile Endophthalmitis Following Intravitreal Injection of Triamacinolone Acetonide. Invest. Ophthalmol. Vis. Sci. 2008;49(13):973.
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To investigate the incidence of sterile endophthalmitis in patients treated with intravitreal triamcinolone acetonide (IVTA) in 2006, and to describe the clinical profile and management of these patients.
The charts of all consecutive patients treated with a single injection of IVTA (4mg/0.1mL, Kenalog-40, Bristol-Myers-Squibb) at the University of Michigan during 2006 were reviewed and cases of post-injection endophthalmitis identified. Clinical characteristics collected included: baseline best-corrected visual acuity (BCVA), indication for IVTA, interval between IVTA and presentation with "sterile" endophthalmitis, signs and symptoms of endophthalmitis, number of tap and injections performed, other endophthalmitis treatments, culture results, and final BCVA. The dates of all IVTA injections were recorded and all patients were followed for at least 60 days following IVTA injection.
A total of 160 consecutive injections were reviewed. Thirteen cases of suspected "sterile" endophthalmitis were identified. Cases clustered in the summer and fall. There were no cases among the 65 injections performed in January - March or November - December. There were 13 cases identified among the 95 injections (14%) performed between April and October. The initial indications for treatment of these cases included: clinically significant diabetic macular edema (n=6), idiopathic cystoid macular edema (CME) (n=2), retinitis pigmentosa with CME (n=1), exudative Coats’ disease with CME (n=1), exudative age-related macular degeneration (n=1), sympathetic ophthalmia with CME (n=1), resolved Propionibacterium acnes endophthalmitis with CME (n=1). We will also report the mean baseline BCVA, the mean interval to presentation of endophthalmitis, the presenting signs and symptoms (all patients presented with hypopyon), clinical management and the mean final BCVA.
During the summer and fall of 2006, there was a clustering of cases of sterile endophthalmitis following IVTA injection. Specific signs and symptoms were suggestive of a sterile intraocular inflammatory response (possibly related to the preservative benzyl alcohol) in our series. Differentiating cases of sterile endophthalmitis from infectious endophthalmitis is important in determining appropriate clinical management. The clustering of sterile endophthalmitis cases following IVTA injections in our series and those anecdotally reported by other clinicians during the summer and fall of 2006 warrants further scientific investigation.
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