Non–infectious Pseudohypopyon Following Intravitreal Triamcinolone Acetonide (IVTA) Injection

Abstract

Abstract: : Purpose: To evaluate the incidence, distinguishing clinical features, and outcomes of non–infectious pseudohypopyon following IVTA injection. Methods: Retrospective, consecutive case series consisting of all patients with non–infectious pseudohypopyon following IVTA injection. All patients were injected with IVTA using a specific protocol including the use of povidone–iodine preparation of the eyelids, eyelashes, and conjunctiva, use of single–use triamcinolone vials, sterile speculum, use of topical antibiotics, and the avoidance of an anterior chamber paracentesis. Non–infectious pseudohypopyon was defined as the presence of white crystalline opacities with or without fibrin in the anterior chamber and an accumulation in the inferior anterior chamber angle in eyes without intense conjunctival congestion or chemosis. Results: Non–infectious pseudohypopyon occurred in 9 patients after 1,022 IVTA injections (0.9%) in 861 patients. These patients were managed by observation alone without vitreous tap or intravitreal antibiotics. All patients achieved a visual acuity of 20/200 or better at last follow–up. No cases of infectious endophthalmitis occurred after in–house injections of IVTA; however, we have managed 3 patients referred with infectious endophthalmitis after IVTA injection. Distinguishing clinical features between infectious endophthalmitis and non–infectious pseudohypopyon are marked. Referred infectious endophthalmitis cases had severe visual loss, marked fibrin in the anterior chamber, hypopyon, and conjunctival congestion and chemosis. Conclusions: In the current series, non–infectious pseudohypoypon following IVTA injection is uncommon. Provided follow–up care can be maintained, observational management can be considered in eyes with minimal inflammation and presumed triamcinolone crystals causing pseudohypopyon. With a specific protocol for avoidance of infection, no cases of infectious endophthalmitis following IVTA have been encountered among patients at the Bascom Palmer Eye Institute.

Keywords: corticosteroids • endophthalmitis • drug toxicity/drug effects