Presumed Sterile Endophthalmitis Afer Intravitreal Triamcinolone (Kenalog)-More Common and Less Benign Than We Thought?
OBJECTIVE
This study aimed to review the incidence and clinical outcome of presumed sterile endophthalmitis after the off-label use of intravitreal Kenalog injections (triamcinolone acetonide with 1.5% benzyl alcohol) and to compare it with the presumed sterile endophthalmitis incidence after intravitreal Kenacort-A (0.99% benzyl alcohol) at our center.


METHODS
This was a single-center, retrospective, consecutive, interventional case series of all patients who underwent intravitreal Kenalog injections at Hong Kong Eye Hospital from November 1, 2009, to July 31, 2012.


METHODS
This was a retrospective medical records review.


RESULTS
A total of 81 intravitreal Kenalog injections were performed. Ten eyes (12.3%) developed presumed sterile endophthalmitis, presenting clinically with dense anterior chamber cells, fibrin, hypopyon, and vitritis. All cases were treated with topical steroids and antibiotics. Although the inflammation resolved eventually in all cases, 2 eyes developed complications, resulting in eventual loss of best corrected visual acuity: one developed rhegmatogenous retinal detachment with choroidal detachment, and another developed vitreous hemorrhage.


CONCLUSIONS
The rate of presumed sterile endophthalmitis after Kenalog injection is much higher than our previous experience with Kenacort-A. To the best of our knowledge, this is the first study reporting the incidence of presumed sterile endophthalmitis using intravitreal Kenalog and Kenacort in the same center using the same injection technique. We believe that it may be due to a difference in the concentration of the preservative. Although sterile endophthalmitis is generally thought to run a benign course, this study has shown that serious complications may occur.
Hong Kong Eye Hospital, Kowloon, Hong Kong.|Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong.
Angie H C
AH
Fong
Hong Kong Eye Hospital, Kowloon, Hong Kong.|Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong.
Carmen K M
CK
Chan
D019905:Benzyl Alcohol / Q000008:administration & dosage; D015862:Choroid Diseases / Q000209:etiology; D009877:Endophthalmitis / Q000139:chemically induced* / Q000150:complications / Q000453:epidemiology*; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D058449:Intravitreal Injections / Q000009:adverse effects*; D011310:Preservatives, Pharmaceutical; D012163:Retinal Detachment / Q000209:etiology; D012189:Retrospective Studies; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000009:adverse effects*; D014792:Visual Acuity; D014823:Vitreous Hemorrhage / Q000209:etiology
D005938:Glucocorticoids; D011310:Preservatives, Pharmaceutical; D014222:Triamcinolone Acetonide; D019905:Benzyl Alcohol
dosage/adverse effects; endophthalmitis; inflammation; intravitreal injections; retinal diseases/drug therapy; triamcinolone acetonide/administration