Clinical Manifestations of Presumed Sterile Endophthalmitis After Intravitreal Triamcinolone Injection

Wool Suh; Soo Young Lee; Jeong-Hee Lee

doi:10.3341/jkos.2008.49.3.464

Journal List > J Korean Ophthalmol Soc > v.49(3) > 1008212

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Suh, Lee, and Lee: Clinical Manifestations of Presumed Sterile Endophthalmitis After Intravitreal Triamcinolone Injection

Original Article

J Korean Ophthalmol Soc 2008;49(3):464-470.

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.3.464

Clinical Manifestations of Presumed Sterile Endophthalmitis After Intravitreal Triamcinolone Injection

Wool Suh, M.D., Soo Young Lee, M.D., Jeong-Hee Lee, M.D.

Department of Ophthalmology, College of Medicine, Ewha Womans University, Seoul, Korea

Address reprint requests to Jeong-Hee Lee, M.D. Department of Ophthalmology, Ewha Womans University College of Medicine, Mok-dong Hospital #911-1 Mok-dong, Yangcheon-gu, Seoul 158-710, Korea Tel: 82-2-2650-5154, Fax: 82-2-2654-4334, E-mail: leejhoph@ewha.ac.kr

Received 7 March 2007 Accepted 2 October 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the distinguishing characteristics that may assist in the clinical diagnosis of sterile endophthalmitis from intravitreal triamcinolone injection.

Methods

From January 2005 to June 2006, the medical records of 163 eyes that received intravitreal triamcinolone injection were reviewed. In 5 eyes of 5 patients who complained of decreasing vision and mild ocular pain within three days after injection, slit lamp bimicroscopy revealed hypopyon, anterior chamber reaction, and vitritis. We analyzed clinical pictures retrospectively.

Results

Intravitreal triamcinolone injections were performed for diabetic macular edema in 4 patients and for panuveitis in 1 patient with Behçet's disease. Pseudophakia was found in all five eyes. Inflammations in three eyes resolved with topical and oral antibiotics within 13 days, and the other two patients were treated with a vitreous culture and intravitreal antibiotic injection. However, vitreous tap showed no evidence of endophthalmitis, and inflammation resolved within the same period.

Conclusions

Presumed sterile endophthalmitis presents within 3 days after intravitreal triamcinolone injection and may be accompanied by decreased vision and ocular discomfort, although it is characterized by no distinct ocular pain. The symptoms and ocular inflammation resolved quickly within 13 days with a favorable visual outcome. Inflammations in three eyes resolved without surgical intervention, so it may be necessary to closely observe clinical manifestations before assuming that the eye is suffering from infectious endophthalmitis.

Keywords: Hypopyon, Intravitreal injection, Triamcinolone acetonide, Sterile endophthalmitis

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Figure 1.

Anterior segment photograph. Multiple subconjunctival hemorrhage is observed at the site of incision. Hypopyon (<1 mm) in the anterior chamber (arrow) is seen on slit lamp examination.

Figure 2.

Anterior segment photograph. The slit lamp examination shows triamcinolone strand (arrow) with vitreous haze in patient 5.

Table 1.

Patient demographics

Case	Age	Sex	Eye	Indication	Predisposing condition	Procedure
1	66	M	OS	DME	DM	IVTA
2	43	M	OD	Panuveitis	Behçet's disease	IVTA
3	57	M	OS	DME	DM	TPPV, PCIOL, laser, IVTA
4	55	M	OS	DME	DM	TPPV, ERM peeling, PCIOL, IVTA
5	53	M	OS	DME	DM	TPPV, ILM peeling, PCIOL, IVTA

M=male; DME=diabetic macular edema; DM=diabetes mellitus; IVTA=intravitreal triamcinolone injection; TPPV=trans pars plana vitrectomy; PCIOL=phacoemulsification and posterior IOL insertion; ERM=epiretinal membrane; ILM=internal limiting membrane.

Table 2.

Signs and symptoms

Case	Symptoms	AC reaction	Hypopyon	Vitritis	Time to presentation (days)
1	no complaint	2+	+	3+	1
2	decreased VA	4+	+	4+	3
3	ocular discomfort	4+	+	4+	2
4	decreased VA	3+		4+	3
5	decreased VA	4+		3+	3

VA=visual acuity; AC=anterior chamber.

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