Abstract
Abstract: :
Purpose: To report on 8 patients who developed clinical signs of endophthalmitis after injection of triamcinolon acetonide. Methods: Intravitreal injection of 4mg in 0.1 ml of aqueous solution of Triamcinolon Acetonide (Triamhexal®, Hexal AG, Holzkirchen, Germany) via pars plana was performed in 271 patients with cystoid macular edema due to exsudative maculopathy. No filter or alcohol substraction procedure was done. Results: 8 out of 271 patients (2.9 %) and 299 injections (2.6 %) developed anterior chamber (AC) fibrin formation, hypopyon, marked infiltration of the vitreous with haze and debris within 24–96 hours after injection. Mean baseline visual acuity (VA) was 20/64, ranging from 20/2000 to 20/30. VA acutely decreased to counting fingers in all patients. 4 patients underwent vitrectomy with vitreous–/AC–tap for presumed infectious endophthalmitis. 4 patients were treated with topical steroids and antibiotics only. Endophthalmitis–like symptoms occurred in patients with preexisting uveitis (3), diabetic maculopathy (2), pseudophakia (2) and branch retinal vein occlusion (1). Despite a marked intraocular inflammatory response and decrease of vision, no patient complained about pain and all had a relatively quiet eye. In the 4 patients who underwent surgery, microbiological cultures under aerob and anaerob conditions were negative. Symptoms resolved immediately after surgery. In the conservative group the symptoms regressed within 1 week. Mean VA during follow–up was 20/80 ranging from 20/2000 to 20/30. Conclusion: Intravitreal injection of triamcinolon may induce endophthalmitis–like symtoms. Typically, microbiological cultures are negative and pseudo–endophthalmitis responds well to topical steroids. In painless eyes a conservative approach may be justified, however infectious endophthalmitis should be considered. Whether the steroid agent or other compounds in the solution are responsible for the inflammatory reaction remains to be determined.
Keywords: clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials • retina • vascular occlusion/vascular occlusive disease