Increased incidence of sterile endophthalmitis following intravitreal preserved triamcinolone acetonide.
OBJECTIVE
To report an increased incidence of sterile endophthalmitis following intravitreal injection of preserved triamcinolone acetonide (IVTA) from 1 May to 31 July 2006.


METHODS
Charts were reviewed for all patients who underwent IVTA injections between 1 January 2005 and 31 July 2006 at the offices of a referral vitreo-retinal practice. Patients were included if they presented post-IVTA with a clinical picture consistent with endophthalmitis.


RESULTS
Between 1 January 2005 and 31 July 2006, 554 eyes underwent IVTA. Eleven eyes (1.9%) developed an endophthalmitis. All eleven eyes underwent vitreous tap and intravitreal injection of antibiotics. All cultures and gram stains were negative for bacterial or fungal organisms. From 1 May to 31 July 2006, 97 eyes underwent IVTA. Nine eyes (9.3%) developed sterile endophthalmitis. This represented a statistically significant (p<0.0001) clustering of cases. Triamcinolone acetonide phials from affected lot numbers were analysed and were all found to be negative for bacterial endotoxin (<0.05 EU/ml).


CONCLUSIONS
Over the 19-month period analysed, 11 cases of sterile endophthalmitis occurred following IVTA, and nine of these cases were clustered over a 3-month period. No endotoxin was detected in the phials tested. The aetiology of this increased incidence of sterile endophthalmitis is still unclear.
Jonisch
J
J
Department of Ophthalmology, North Shore-Long Island Jewish Health System, Great Neck, NY, USA.
Lai
J C
JC
Deramo
V A
VA
Flug
A J
AJ
Fastenberg
D M
DM
D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D009877:Endophthalmitis / Q000139:chemically induced* / Q000503:physiopathology; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D007267:Injections; D008875:Middle Aged; D011310:Preservatives, Pharmaceutical; D014222:Triamcinolone Acetonide / Q000009:adverse effects*; D014792:Visual Acuity; D014822:Vitreous Body
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D011310:Preservatives, Pharmaceutical; D014222:Triamcinolone Acetonide