title: Increased incidence of sterile endophthalmitis following intravitreal preserved triamcinolone acetonide.
abstract: 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.
authors.affiliation: Department of Ophthalmology, North Shore-Long Island Jewish Health System, Great Neck, NY, USA.
authors.forename: J
authors.initials: J
authors.lastname: Jonisch
authors.forename: J C
authors.initials: JC
authors.lastname: Lai
authors.forename: V A
authors.initials: VA
authors.lastname: Deramo
authors.forename: A J
authors.initials: AJ
authors.lastname: Flug
authors.forename: D M
authors.initials: DM
authors.lastname: Fastenberg
mesh_terms: 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
chemical_list: D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D011310:Preservatives, Pharmaceutical; D014222:Triamcinolone Acetonide