Skip to main content

Advertisement

SpringerLink
Log in

Associated factors and treatment outcome of presumed noninfectious endophthalmitis occurring after intravitreal triamcinolone acetonide injection

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Background

To investigate the associated factors and treatment outcomes in patients with presumed noninfectious endophthalmitis after intravitreal triamcinolone acetonide (IVTA) injection.

Methods

Among 219 consecutive cases of 186 patients who had undergone IVTA injection for macular diseases, presumed noninfectious endophthalmitis was diagnosed if the patient showed severe inflammation in the anterior chamber and vitreous cavity within 7 days after injection but no organism was isolated on microbiological examination. Clinical features and previously performed surgical procedures were evaluated to assess their association with presumed noninfectious endophthalmitis using logistic regression. After surgical or medical treatment for endophthalmitis, the visual outcome was evaluated in all patients.

Results

Noninfectious endophthalmitis developed in six of 219 eyes (2.7 %). Previous vitrectomy, history of IVTA injection, and pseudophakia were significantly associated with the occurrence of presumed noninfectious endophthalmitis after IVTA injection (p = 0.049, 0.034, and 0.009, respectively). Internal limiting membrane (ILM) peeling during vitrectomy also showed statistically significant association (odds ratio = 13.6, p = 0.017). Five of six patients (83.3 %) regained pre-injection vision.

Conclusion

In addition to previous vitrectomy, history of IVTA injection, internal limiting membrane (ILM) peeling, and pseudophakia may render the eye vulnerable to presumed noninfectious endophthalmitis following IVTA injection. Visual outcome shows generally good prognosis after treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Jaissle GB, Szurman P, Bartz-Schmidt KU (2004) Ocular side effects and complications of intravitreal triamcinolone acetonide injection. Ophthalmologe 101:121–128

    Article  PubMed  CAS  Google Scholar 

  2. Cohen SM, Flynn HW Jr, Murray TG, Smiddy WE (1995) Endophthalmitis after pars plana vitrectomy. The Postvitrectomy Endophthalmitis Study Group. Ophthalmology 102:705–712

    PubMed  CAS  Google Scholar 

  3. Maia M, Farah ME, Belfort RN, Penha FM, Lima Filho AA, Aggio FB, Belfort R Jr (2007) Effects of intravitreal triamcinolone acetonide injection with and without preservative. Br J Ophthalmol 91:1122–1124

    Article  PubMed  Google Scholar 

  4. Moshfeghi DM, Kaiser PK, Bakri SJ, Kaiser RS, Maturi RK, Sears JE, Scott IU, Belmont J, Beer PM, Quiroz-Mercado H, Mieler WF (2005) Presumed sterile endophthalmitis following intravitreal triamcinolone acetonide injection. Ophthalmic Surg Lasers Imaging 36:24–29

    PubMed  Google Scholar 

  5. Moshfeghi DM, Kaiser PK, Scott IU, Sears JE, Benz M, Sinesterra JP, Kaiser RS, Bakri SJ, Maturi RK, Belmont J, Beer PM, Murray TG, Quiroz-Mercado H, Mieler WF (2003) Acute endophthalmitis following intravitreal triamcinolone acetonide injection. Am J Ophthalmol 136:791–796

    Article  PubMed  CAS  Google Scholar 

  6. Nelson ML, Tennant MT, Sivalingam A, Regillo CD, Belmont JB, Martidis A (2003) Infectious and presumed noninfectious endophthalmitis after intravitreal triamcinolone acetonide injection. Retina 23:686–691

    Article  PubMed  Google Scholar 

  7. Roth DB, Chieh J, Spirn MJ, Green SN, Yarian DL, Chaudhry NA (2003) Noninfectious endophthalmitis associated with intravitreal triamcinolone injection. Arch Ophthalmol 121:1279–1282

    Article  PubMed  Google Scholar 

  8. Stepien KE, Eaton AM, Jaffe GJ, Davis JL, Raja J, Feuer W (2009) Increased incidence of sterile endophthalmitis after intravitreal triamcinolone acetonide in spring 2006. Retina 29:207–213

    Article  PubMed  Google Scholar 

  9. Taban M, Singh RP, Chung JY, Lowder CY, Perez VL, Kaiser PK (2007) Sterile endophthalmitis after intravitreal triamcinolone: a possible association with uveitis. Am J Ophthalmol 144:50–54

    Article  PubMed  CAS  Google Scholar 

  10. Wang LC, Yang CM (2005) Sterile endophthalmitis following intravitreal injection of triamcinolone acetonide. Ocul Immunol Inflamm 13:295–300

    Article  PubMed  CAS  Google Scholar 

  11. Klein KS, Walsh MK, Hassan TS, Halperin LS, Castellarin AA, Roth D, Driscoll S, Prenner JL (2009) Endophthalmitis after anti-VEGF injections. Ophthalmology 116:1225

    Article  PubMed  Google Scholar 

  12. Jonisch J, Lai JC, Deramo VA, Flug AJ, Fastenberg DM (2008) Increased incidence of sterile endophthalmitis following intravitreal preserved triamcinolone acetonide. Br J Ophthalmol 92:1051–1054

    Article  PubMed  CAS  Google Scholar 

  13. Lorenzo Carrero J, Gonzalez Barcia M, Perez Flores I (2008) Sterile endophthalmitis after benzyl alcohol filtered triamcinolone acetonide injection. Arch Ophthalmol 126:142–143

    Article  PubMed  Google Scholar 

  14. Westfall AC, Osborn A, Kuhl D, Benz MS, Mieler WF, Holz ER (2005) Acute endophthalmitis incidence: intravitreal triamcinolone. Arch Ophthalmol 123:1075–1077

    Article  PubMed  Google Scholar 

  15. Yoon SJ, Rhee DY, Marx JL, Blaha GR, Rogers AH, Baumal CR, Reichel E, Duker JS (2009) Anatomic and visual outcomes of noninfectious endophthalmitis after intravitreal triamcinolone. Am J Ophthalmol 147:1031–1036

    Article  PubMed  CAS  Google Scholar 

  16. Roth DB, Flynn HW Jr (2008) Distinguishing between infectious and noninfectious endophthalmitis after intravitreal triamcinolone injection. Am J Ophthalmol 146:346–347

    Article  PubMed  Google Scholar 

  17. Roth DB, Realini T, Feuer WJ, Radhakrishnan R, Gloth J, Heimmel MR, Fechtner RD, Yarian DL, Green SN (2008) Short-term complications of intravitreal injection of triamcinolone acetonide. Retina 28:66–70

    Article  PubMed  Google Scholar 

  18. Holland SP, Mathias RG, Morck DW, Chiu J, Slade SG (2000) Diffuse lamellar keratitis related to endotoxins released from sterilizer reservoir biofilms. Ophthalmology 107:1227–1233

    Article  PubMed  CAS  Google Scholar 

  19. Almony A, Nudleman E, Shah GK, Blinder KJ, Eliott DB, Mittra RA, Tewari A (2012) Techniques, rationale, and outcomes of internal limiting membrane peeling. Retina 32:877–891

    Article  PubMed  Google Scholar 

  20. Greenberg PB, Martidis A, Rogers AH, Duker JS, Reichel E (2002) Intravitreal triamcinolone acetonide for macular oedema due to central retinal vein occlusion. Br J Ophthalmol 86:247–248

    Article  PubMed  Google Scholar 

  21. Hartley KL, Smiddy WE, Flynn HW Jr, Murray TG (2008) Pars plana vitrectomy with internal limiting membrane peeling for diabetic macular edema. Retina 28:410–419

    Article  PubMed  Google Scholar 

  22. Ip MS, Gottlieb JL, Kahana A, Scott IU, Altaweel MM, Blodi BA, Gangnon RE, Puliafito CA (2004) Intravitreal triamcinolone for the treatment of macular edema associated with central retinal vein occlusion. Arch Ophthalmol 122:1131–1136

    Article  PubMed  CAS  Google Scholar 

  23. Antcliff RJ, Spalton DJ, Stanford MR, Graham EM, Ffytche TJ, Marshall J (2001) Intravitreal triamcinolone for uveitic cystoid macular edema: an optical coherence tomography study. Ophthalmology 108:765–772

    Article  PubMed  CAS  Google Scholar 

  24. Christensen UC (2009) Value of internal limiting membrane peeling in surgery for idiopathic macular hole and the correlation between function and retinal morphology. Acta Ophthalmol 87:1–23

    PubMed  Google Scholar 

  25. Ito Y, Terasaki H, Takahashi A, Yamakoshi T, Kondo M, Nakamura M (2005) Dissociated optic nerve fiber layer appearance after internal limiting membrane peeling for idiopathic macular holes. Ophthalmology 112:1415–1420

    Article  PubMed  Google Scholar 

  26. Rubinstein A, Bates R, Benjamin L, Shaikh A (2005) Iatrogenic eccentric full thickness macular holes following vitrectomy with ILM peeling for idiopathic macular holes. Eye (Lond) 19:1333–1335

    Article  CAS  Google Scholar 

  27. Dugel PU, Rao NA, Ozler S, Liggett PE, Smith RE (1992) Pars plana vitrectomy for intraocular inflammation-related cystoid macular edema unresponsive to corticosteroids. A preliminary study. Ophthalmology 99:1535–1541

    PubMed  CAS  Google Scholar 

  28. Rothova A, Suttorp-van Schulten MS, Frits Treffers W, Kijlstra A (1996) Causes and frequency of blindness in patients with intraocular inflammatory disease. Br J Ophthalmol 80:332–336

    Article  PubMed  CAS  Google Scholar 

  29. Lasave AF, Zeballos DG, El-Haig WM, Diaz-Llopis M, Salom D, Arevalo JF (2009) Short-term results of a single intravitreal bevacizumab (avastin) injection versus a single intravitreal triamcinolone acetonide (kenacort) injection for the management of refractory noninfectious uveitic cystoid macular edema. Ocul Immunol Inflamm 17:423–430

    Article  PubMed  CAS  Google Scholar 

  30. Joussen AM, Smyth N, Niessen C (2007) Pathophysiology of diabetic macular edema. Dev Ophthalmol 39:1–12

    Article  PubMed  CAS  Google Scholar 

  31. Metrikin DC, Wilson CA, Berkowitz BA, Lam MK, Wood GK, Peshock RM (1995) Measurement of blood-retinal barrier breakdown in endotoxin-induced endophthalmitis. Investig Ophthalmol Vis Sci 36:1361–1370

    CAS  Google Scholar 

  32. Endophthalmitis Vitrectomy Study Group (1995) Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Arch Ophthalmol 113:1479–1496

    Article  Google Scholar 

Download references

Conflict of interest

The author declares no conflicts of interest.

Author information

Authors and Affiliations

  1. Departmant of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea

    Seong Joon Ahn

  2. Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea

    Seong Joon Ahn, Tae Wan Kim, Jeeyun Ahn, Jang Won Huh, Hyeong Gon Yu & Hum Chung

  3. Department of Ophthalmology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, #395 Shindaebang-2-dong, Dongjak-gu, Seoul, 156-707, Korea

    Tae Wan Kim & Jeeyun Ahn

Authors
  1. Seong Joon Ahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tae Wan Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jeeyun Ahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jang Won Huh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hyeong Gon Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hum Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tae Wan Kim.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ahn, S.J., Kim, T.W., Ahn, J. et al. Associated factors and treatment outcome of presumed noninfectious endophthalmitis occurring after intravitreal triamcinolone acetonide injection. Graefes Arch Clin Exp Ophthalmol 251, 715–723 (2013). https://doi.org/10.1007/s00417-012-2111-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-012-2111-8

Keywords

Search

Navigation