J Korean Ophthalmol Soc.  2008 Mar;49(3):464-470. 10.3341/jkos.2008.49.3.464.

Clinical Manifestations of Presumed Sterile Endophthalmitis After Intravitreal Triamcinolone Injection

• Suh W
• Lee SY
• Lee JH

• KMID: 2211320
• DOI: http://doi.org/10.3341/jkos.2008.49.3.464

Abstract

PURPOSE: To evaluate the distinguishing characteristics that may assist in the clinical diagnosis of sterile endophthalmitis from intravitreal triamcinolone injection.
METHODS
From January 2005 to June 2006, the medical records of 163 eyes that received intravitreal triamcinolone injection were reviewed. In 5 eyes of 5 patients who complained of decreasing vision and mild ocular pain within three days after injection, slit lamp bimicroscopy revealed hypopyon, anterior chamber reaction, and vitritis. We analyzed clinical pictures retrospectively.
RESULTS
Intravitreal triamcinolone injections were performed for diabetic macular edema in 4 patients and for panuveitis in 1 patient with Behcet's disease. Pseudophakia was found in all five eyes. Inflammations in three eyes resolved with topical and oral antibiotics within 13 days, and the other two patients were treated with a vitreous culture and intravitreal antibiotic injection. However, vitreous tap showed no evidence of endophthalmitis, and inflammation resolved within the same period.
CONCLUSIONS
Presumed sterile endophthalmitis presents within 3 days after intravitreal triamcinolone injection and may be accompanied by decreased vision and ocular discomfort, although it is characterized by no distinct ocular pain. The symptoms and ocular inflammation resolved quickly within 13 days with a favorable visual outcome. Inflammations in three eyes resolved without surgical intervention, so it may be necessary to closely observe clinical manifestations before assuming that the eye is suffering from infectious endophthalmitis.

Keyword

Hypopyon; Intravitreal injection; Triamcinolone acetonide; Sterile endophthalmitis

MeSH Terms

Anterior Chamber
Anti-Bacterial Agents
Endophthalmitis
Eye
Humans
Inflammation
Intravitreal Injections
Macular Edema
Medical Records
Panuveitis
Pseudophakia
Retrospective Studies
Stress, Psychological
Triamcinolone
Triamcinolone Acetonide
Vision, Ocular
Anti-Bacterial Agents
Triamcinolone
Triamcinolone Acetonide

Figure

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  Figure 1. Anterior segment photograph. Multiple subconjunctival hemorrhage is observed at the site of incision. Hypopyon (<1 mm) in the anterior chamber (arrow) is seen on slit lamp examination.

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  Figure 2. Anterior segment photograph. The slit lamp examination shows triamcinolone strand (arrow) with vitreous haze in patient 5.

Reference

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