Presumed Noninfectious Endophthalmitis after Intravitreal Injection of Triamcinolone Acetonide

Park, Hyun Jun; Park, Jun Mo; Oum, Boo Sup

Abstract

PURPOSE
We report a case of presumed noninfectious endophthalmitis following intravitreal triamcinolone acetonide injection. METHODS: A 63-year-old female patient was treated with intravitreal triamcinolone acetonide for diabetic macular edema in her right eye. Two days after the injection, the patient complained of decreased visual acuity but didn't visit the hospital until five days after the injection. Visual acuity had dropped to hand motion, and the slit lamp examination showed 3+ cells and hypopyon in the anterior chamber. In the vitreous there was a dense haze completely obscuring the view of the fundus. RESULTS: The position of the hypopyon was gravity dependent and shifted with changes in the patient's head position. Vitreous taps and culture were performed followed by the intravitreal injection of vancomycin and ceftazidime. The anterior chamber had cleared and hypopyon resolved completely eight days after the original injection, but the diffuse vitreous haze remained. The vitreous haze resolved slowly over four weeks and visual acuity recovered to baseline vision. CONCLUSIONS: In the presence of inflammation signs after intravitreal triamcinolone acetonide injection, the differentiation of infectious endophthalmitis from noninfectious endophthalmitis is mandatory. The pseudohypopyon was distinguishable from an infective or inflammatory hypopyon by its shifting position, which was dependent upon the patient's head position. Close observation and differential diagnosis are needed to avoid unnecessary surgical intervention.