title: Viral retinitis after intravitreal triamcinolone injection in patients with predisposing medical comorbidities.
abstract: OBJECTIVE
  To review the cases of viral retinitis after intravitreal steroid administration at a single center, to estimate the incidence, and to propose risk factors for its occurrence.
  
  
  METHODS
  Retrospective, observational case series.
  
  
  METHODS
  Seven hundred thirty-six intravitreal triamcinolone (IVTA) injections were administered in the clinic and operating room by 3 retina specialists at a single academic medical center between September 2002 and November 2008. Inclusion criteria were simply a history of 1 or more IVTA injections during the period. The overall incidence of viral retinitis after IVTA injection was calculated. Subsequently, a chart audit was performed to estimate the number of patients with immune-altering conditions who had received IVTA during the period, and the incidence within this subgroup was calculated.
  
  
  RESULTS
  Viral retinitis developed after IVTA injection in 3 patients, yielding an overall incidence of 3 in 736 or 0.41%. An estimated 334 injections were administered to patients with an immune-altering condition, including diabetes. All 3 of the patients in whom viral retinitis developed after IVTA injection possessed abnormal immune systems, yielding an incidence rate of 3 in 334 or 0.90% within this subgroup.
  
  
  CONCLUSIONS
  Our high reported incidence for this potentially devastating complication can be attributed to multiple factors, including coexisting medical immunocompromising comorbidities, a higher dose with a longer duration of local immunosuppression in the vitreous, multiple injections, as well as previous viral retinitis. Caution with a high index of clinical suspicion and frequent follow-up is advised in patients receiving IVTA injection with potentially immune-altering conditions, even after apparent immune recovery.
authors.affiliation: Jacobs Retina Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California 92093, USA.
authors.forename: Ankur M
authors.initials: AM
authors.lastname: Shah
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Oster
authors.forename: William R
authors.initials: WR
authors.lastname: Freeman
mesh_terms: D000328:Adult; D000368:Aged; D015984:Causality; D017726:Cytomegalovirus Retinitis / Q000453:epidemiology / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D015658:HIV Infections / Q000150:complications; D006563:Herpes Zoster Ophthalmicus / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007267:Injections; D008269:Macular Edema / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000150:complications; D015882:Retinal Necrosis Syndrome, Acute / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014222:Triamcinolone Acetonide / Q000009:adverse effects*; D014792:Visual Acuity; D014822:Vitreous Body
chemical_list: D005938:Glucocorticoids; D014222:Triamcinolone Acetonide