Safety of Intravitreal Triamcinolone Injection With and Without Preservative in Humans Subjects

Abstract

Purpose:: To evaluate the effects of intravitreal injection of preservative-free triamcinolone acetonide (TA) and TA containing preservative (KE).

Methods:: A retrospective review was conducted of 646 intravitreal steroid injections in 475 eyes. A total of 577 intravitreal injections of preservative-free TA and 69 intravitreal KE injections were administered. No supernatant removal was performed. Noninfectious endophthalmitis was defined as pseudohypopyon/hypopyon with or without an inflammatory reaction that regressed after steroid eye drop instillation. Eyes were examined at all postoperative visits. Statistical analysis was performed using Fisher test and P-values<0.05 were considered significant.

Results:: Follow-up ranged from 1 to 57 months (mean, 13±7.5). Intraocular pressure (IOP) increased in 128 eyes (19,8%) following 646 injections: 19.1% after 577 preservative-free TA injections and 26,1% after 69 KE injections (P = 0.167 for comparison of two groups). From eyes with high IOP, 3.15% required trabeculectomy.Noninfectious endophthalmitis developed in 12 eyes (1.9%) after 646 intravitreal steroid injections. Seven eyes injected with preservative free TA (1.2%) developed pseudohypopyon without pain or redness. Five eyes injected with KE (7.3%) developed pseudohypopyon and painful eye (P = 0.005 for the comparison of the two groups). One eye with bacterial endophthalmitis (0.15%) was observed following 646 injections.

Conclusions:: Noninfectious endophthalmitis developed in 1.9% of eyes after intravitreal steroid injections, but it was observed significantly more often after KE injections (7.3%) compared with preservative-free TA injections (1.2%) (P < 0.05). An inflammatory reaction was more clinically relevant in the KE group than in the preservative-free TA group. These data may be relevant to optimize intraocular steroid use.

Keywords: drug toxicity/drug effects • macula/fovea • endophthalmitis