gms | German Medical Science

102. Jahrestagung der DOG

Deutsche Ophthalmologische Gesellschaft e. V.

23. bis 26.09.2004, Berlin

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Complications of infectious and sterile endophthalmitis after intravitreal Triamcinolone Acetonide

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  • corresponding author I. Kreissig - Department of Ophthalmology, Faculty of Clinical Medicine Mannheim, University of Heidelberg, Germany
  • R. Degenring - Department of Ophthalmology, Faculty of Clinical Medicine Mannheim, University of Heidelberg, Germany
  • J. Jonas - Department of Ophthalmology, Faculty of Clinical Medicine Mannheim, University of Heidelberg, Germany

Evidenzbasierte Medizin - Anspruch und Wirklichkeit. 102. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft. Berlin, 23.-26.09.2004. Düsseldorf, Köln: German Medical Science; 2004. Doc04dogFR.04.12

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dog2004/04dog199.shtml

Published: September 22, 2004

© 2004 Kreissig et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective

Intravitreal Triamcinolone Acetonide (TA), applied as treatment for various edematous and neovascular ocular diseases, will be analyzed for the complications of infectious endophthalmitis and sterile intraocular inflammation (pseudo-endophthalmitis).

Methods

In a clinical interventional study 577 consecutive eyes were analyzed, which were treated between April 7, 1999 and December 22, 2003 with about 20-25mg TA for various edematous and neovascular ocular diseases. Vehicle of the crystal suspension was removed under sterile conditions and injection performed in the operating room with patient prepared and draped as for intraocular surgery. Ninety-eight eyes received a second intravitreal injection, 20 a third , 3 a fourth, 1 eye a fifth, and 1 a sixth injection, adding up to a total of 700 intravitreal injections. Mean follow-up 7.2 ± 7,3 months (median 5.0 months).

Results

One day and 1 week after injection, there were no: hypopyon, marked Tyndall (>++), and inflammatory cells in the anterior chamber or vitreous cavity. In 1 eye, white crystals were present in the inferior anterior chamber angle resembling an hypopyon. An anterior chamber lavage demonstrated TA-crystals; the culture was negative for bacteria and fungi. One 86-year old patient with a quiet eye during the 1st week after injection, fell in her home during the 2nd week, which resulted in a perforating injury of the injected eye. The patient was not found until 2 days after the ocular perforation being almost unconscious. A 2-year old cataract wound had re-opened, the eye showed signs of infectious endophthalmitis, the eye had to be enucleated; the histology revealed infectious endophthalmitis.

Conclusions

Intravitreal injections of TA may not be associated with a high risk of infectious endophthalmitis or sterile intraocular inflammation, if removal of the solvent and the intravitreal injections are performed under sterile conditions. One might speculate whether the 1 infectious endophthalmitis out of a total of 700 injections may not have been caused by the primary intravitreal TA-injection, but instead by a secondary external infection, induced by the incured ocular perforating injury.