Sterile Endophthalmitis Associated with Intravitreal Triamcinolone Injection

Abstract

Abstract: : Purpose: Intravitreal injection of triamcinolone has been advocated to treat exudative macular diseases, such as macular edema and choroidal neovascularization. We report seven cases of patients who developed a clinical picture simulating endophthalmitis after intravitreal triamcinolone injection. Methods: Intravitreal triamcinolone injections were performed to treat refractory cystoid macular edema (CME) or diffuse macular edema associated with diabetic retinopathy, macular pucker, branch retinal vein occlusion, or pseudophakia. One patient was injected in an attempt to treat exudation associated with occult choroidal neovascularization. Results: The pre-injection visual acuity ranged from 20/50 to 20/200. An extensive inflammatory response developed between one and two days after injection in all seven eyes. Five of seven eyes had previously been vitrectomized. Four of seven eyes presented with a layered hypopyon. All seven eyes presented with an anterior chamber cellular reaction and vitritis. The visual acuity ranged from 20/400 to hand movements. Conclusions: The first six patients were treated as bona fide endophthalmitis, with vitreous cultures and intravitreal injections of antibiotics. All six eyes failed to grow organisms and resolved their inflammatory response with recovery to pre-injection visual acuity or better. The seventh patient was treated with topical prednisolone acetate without antibiotic therapy and the inflammation resolved, with resolution of the macular edema seen before the intravitreal triamcinolone injection.

Keywords: drug toxicity/drug effects • endophthalmitis • clinical (human) or epidemiologic studies: out