Uveitis may increase risk of sterile endophthalmitis after triamcinolone injections

A history of uveitis may increase the risk of developing sterile endophthalmitis after treatment with intravitreal triamcinolone acetonide for various retinal pathologies, according to a study by researchers at the Cole Eye Institute.

Peter K. Kaiser, MD, and colleagues reviewed records for all patients who received intravitreal triamcinolone acetonide at their center between January and September 2006. The study included 310 eyes treated for such retinal diseases as age-related macular degeneration, diabetic retinopathy, vascular occlusion and cystoid macular edema caused by uveitis.

Of the 310 patients reviewed, 20 had a prior history of uveitis, the authors noted.

The researchers found that no patients developed culture-positive infectious endophthalmitis. However, six patients (1.9%) developed sterile endophthalmitis a mean of 1.7 days after intravitreal injection.

These six patients averaged 68 years of age, ranging from 53 to 83 years, and four patients had a prior history of uveitis. Also, all six eyes were pseudophakic, three had previously undergone vitrectomy and three had previously been treated with intravitreal triamcinolone without complications, according to the study.

"All six patients sought treatment within 3 days of injection, and all recovered rapidly," the authors said.

Surgeons performed a vitreous tap and injected antibiotics in all six eyes.

"Most samples were positive for polymorphonuclear neutrophils or mononuclear cells, but none had positive bacterial or fungal cultures after 14 days. All recovered baseline preinjection vision or better, with a median final visual acuity of 20/80 [or worse] after a median of 26 days," the authors wrote.

Final visual acuity averaged 20/60 for the four patients with a history of uveitis roughly 4 weeks after their intravitreal triamcinolone injection, they noted.

The study is published in the July issue of American Journal of Ophthalmology.