Toxic vitreitis outbreak after intravitreal injection.
OBJECTIVE
To report clinical and epidemiologic findings of 11 patients with severe intraocular inflammation after intravitreal injection.


METHODS
This is a single-center, retrospective, interventional case series of 11 patients with severe intraocular inflammation after intravitreal injection at 1 referral center. The clinical data of all patients (3,357) who underwent intravitreal injection between February 2007 and February 2008 were analyzed. All incidents of postoperative intraocular inflammatory reaction were documented.


RESULTS
During the examination period, we identified 11 cases of intraocular inflammation after intravitreal injection. Only one thereof was infectious endophthalmitis with retinal abscess. All others were toxic vitreitis. Seven eyes exhibited hypopyon and five disseminated retinal hemorrhages. The toxic reaction occurred within 48 hours after injection, whereas in the endophthalmitis case, it occurred after 72 hours. We believe that the cause of this reaction was the particular syringe brand used. After changing to another syringe brand, no further cases of toxic vitreitis occurred during the next 6 months.


CONCLUSIONS
Toxic inflammatory reaction is not only a complication of cataract surgery, but may also occur after intravitreal injection. A critical review of all processes involved and materials used would help to prevent further cases of toxic vitreitis.
Ness
Thomas
T
University Hospital Freiburg, Eye Hospital, Freiburg, Germany. thomas.ness@uniklinik-freiburg.de
Feltgen
Niklas
N
Agostini
Hansjuergen
H
Böhringer
Daniel
D
Lubrich
Beate
B
D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D004196:Disease Outbreaks; D005128:Eye Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D007267:Injections; D008268:Macular Degeneration / Q000188:drug therapy; D008269:Macular Edema / Q000188:drug therapy; D008297:Male; D000069579:Ranibizumab; D012166:Retinal Hemorrhage / Q000175:diagnosis; D012189:Retrospective Studies; D013492:Suppuration / Q000175:diagnosis; D013594:Syringes / Q000009:adverse effects*; D014222:Triamcinolone Acetonide / Q000008:administration & dosage; D014822:Vitreous Body / Q000473:pathology*
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D014222:Triamcinolone Acetonide; D000069579:Ranibizumab