Acute endophthalmitis following intravitreal triamcinolone acetonide injection.
OBJECTIVE
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).


METHODS
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.
Stanford University Department of Ophthalmology, Stanford, California, USA.
Darius M
DM
Moshfeghi
Peter K
PK
Kaiser
Ingrid U
IU
Scott
Jonathan E
JE
Sears
Matthew
M
Benz
Juan P
JP
Sinesterra
Richard S
RS
Kaiser
Sophie J
SJ
Bakri
Raj K
RK
Maturi
Jonathan
J
Belmont
Paul M
PM
Beer
Timothy G
TG
Murray
Hugo
H
Quiroz-Mercado
William F
WF
Mieler
D000208:Acute Disease; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007267:Injections; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D014792:Visual Acuity; D014821:Vitrectomy; D014822:Vitreous Body / Q000187:drug effects / Q000382:microbiology
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D014222:Triamcinolone Acetonide