Increased incidence of sterile endophthalmitis following intravitreal triamcinolone acetonide

Researchers retrospectively reviewed the charts of all patients who underwent intravitreal triamcinolone acetonide (IVTA) injections performed at a single vitreo-retinal practice between Jan. 1, 2005 and July 31, 2006. They found a statistically significant clustering of cases of sterile endophthalmitis following IVTA. Eleven eyes, or 1.9 percent, developed an endophthalmitis, nine of which were clustered over a three-month period.

All affected eyes underwent vitreous tap and intravitreal injection of antibiotics. All cultures and gram stains were negative for bacterial or fungal organisms. Triamcinolone acetonide phials from affected lot numbers were also negative for bacterial endotoxin. Although FDA has approved a preservative-free formulation of TA for intraocular use (Triesence; Alcon Laboratoy, Fort Worth, TX), the side-effect profile of TA with and without preservatives needs further study as the etiology of sterile endophthalmitis is still unclear.