Acute endophthalmitis following intravitreal triamcinolone acetonide injection

Am J Ophthalmol. 2003 Nov;136(5):791-6. doi: 10.1016/s0002-9394(03)00483-5.


Purpose: To report the clinical features, causative organisms, management, and visual acuity outcomes of eight eyes of eight patients who developed acute postoperative endophthalmitis following intravitreal injection of triamcinolone acetonide (IVTA).

Design: Retrospective, multicenter, interventional, case series.

Methods: A retrospective, interventional, case series of all patients with acute postoperative endophthalmitis following IVTA at seven academic clinical centers between March 2001 and July 2002.

Results: A total of 922 IVTAs were performed. Eight eyes of eight patients with acute postoperative endophthalmitis were identified in the 6 weeks following IVTA for an incidence of 0.87% (95% confidence interval of 0.38% to 1.70%). The median time to presentation was 7.5 days (range, 1-15 days) after IVTA. The most common clinical findings were iritis (n = 8), vitritis (n = 8), hypopyon (n = 8), pain (n = 7), red eye (n = 6), and decreased vision (n = 5). The median presenting visual acuity was 20/1127 (range, 20/60 to light perception). Initial treatment consisted of vitreous tap and injection of antibiotics (n = 6) or pars plana vitrectomy and injection of intravitreal antibiotics (n = 2). Intraocular cultures yielded identification in seven patients. One demonstrated intracellular gram-positive cocci in chains with numerous polymorphonuclear cells on gram stain. The median postinfection vision was 20/400 (range, 20/40 to no light perception). Three patients ended up with no light perception visual acuity, including enucleation (n = 1) and phthisis (n = 1).

Conclusions: Acute postoperative endophthalmitis following IVTA occurs rapidly and can result in severe loss of vision.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Anti-Inflammatory Agents / administration & dosage*
  • Endophthalmitis / diagnosis
  • Endophthalmitis / drug therapy
  • Endophthalmitis / microbiology*
  • Eye Infections, Bacterial / diagnosis
  • Eye Infections, Bacterial / drug therapy
  • Eye Infections, Bacterial / microbiology*
  • Female
  • Humans
  • Incidence
  • Injections
  • Male
  • Middle Aged
  • Postoperative Complications*
  • Retrospective Studies
  • Triamcinolone Acetonide / administration & dosage*
  • Visual Acuity
  • Vitrectomy
  • Vitreous Body / drug effects
  • Vitreous Body / microbiology


  • Anti-Bacterial Agents
  • Anti-Inflammatory Agents
  • Triamcinolone Acetonide