Acute endophthalmitis following intravitreal triamcinolone acetonide injection - 26/08/11

Doi : 10.1016/S0002-9394(03)00483-5

Darius M Moshfeghi, MD ^a, Peter K Kaiser, MD ^b,^⁎ , Ingrid U Scott, MD, MPH ^c, Jonathan E Sears, MD ^b, Matthew Benz, MD ^c, Juan P Sinesterra, MD ^d, Richard S Kaiser, MD ^e, Sophie J Bakri, MD ^f, Raj K Maturi, MD ^g, Jonathan Belmont, MD ^e, Paul M Beer, MD ^f, Timothy G Murray, MD ^c, Hugo Quiroz-Mercado, MD ^d, William F Mieler, MD ^h
^a Stanford University Department of Ophthalmology, Stanford, California, USA (D.M.M.)
^b Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA (P.K.K., J.E.S.)
^c Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, USA (I.U.S., M.B., T.G.M.)
^d APEC, Mexico City, Mexico (J.P.S., H.Q.-M.)
^e Wills Eye Hospital, Philadelphia, Pennsylvania, USA (R.S.K., J.B.)
^f Albany Medical College, Albany, New York, USA (S.J.B., P.M.B.)
^g Midwest Eye Institute, Indianapolis, Indiana, USA (R.K.M.)
^h Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA (W.F.M.)

^*Corresponding author: Peter K. Kaiser, MD, Cole Eye Institute, 9500 Euclid Ave., Desk i-32, Cleveland, OH 44195, USA; fax: (216) 445-2226

Abstract

Purpose

To report the clinical features, causative organisms, management, and visual acuity outcomes of eight eyes of eight patients who developed acute postoperative endophthalmitis following intravitreal injection of triamcinolone acetonide (IVTA).

Design

Retrospective, multicenter, interventional, case series.

Methods

A retrospective, interventional, case series of all patients with acute postoperative endophthalmitis following IVTA at seven academic clinical centers between March 2001 and July 2002.

Results

A total of 922 IVTAs were performed. Eight eyes of eight patients with acute postoperative endophthalmitis were identified in the 6 weeks following IVTA for an incidence of 0.87% (95% confidence interval of 0.38% to 1.70%). The median time to presentation was 7.5 days (range, 1–15 days) after IVTA. The most common clinical findings were iritis (n = 8), vitritis (n = 8), hypopyon (n = 8), pain (n = 7), red eye (n = 6), and decreased vision (n = 5). The median presenting visual acuity was 20/1127 (range, 20/60 to light perception). Initial treatment consisted of vitreous tap and injection of antibiotics (n = 6) or pars plana vitrectomy and injection of intravitreal antibiotics (n = 2). Intraocular cultures yielded identification in seven patients. One demonstrated intracellular gram-positive cocci in chains with numerous polymorphonuclear cells on gram stain. The median postinfection vision was 20/400 (range, 20/40 to no light perception). Three patients ended up with no light perception visual acuity, including enucleation (n = 1) and phthisis (n = 1).

Conclusions

Acute postoperative endophthalmitis following IVTA occurs rapidly and can result in severe loss of vision.

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Plan

InternetAdvance publication at ajo.com May 7, 2003.
Supported, in part, by The Ronald G. Michels Fellowship Foundation, Baltimore, MD (D.M.M.) and Diabetes Association of Greater Cleveland (P.K.K.).