Viral retinitis after intravitreal triamcinolone injection in patients with predisposing medical comorbidities.

Abstract

PURPOSE:

To review the cases of viral retinitis after intravitreal steroid administration at a single center, to estimate the incidence, and to propose risk factors for its occurrence.

DESIGN:

Retrospective, observational case series.

METHODS:

Seven hundred thirty-six intravitreal triamcinolone (IVTA) injections were administered in the clinic and operating room by 3 retina specialists at a single academic medical center between September 2002 and November 2008. Inclusion criteria were simply a history of 1 or more IVTA injections during the period. The overall incidence of viral retinitis after IVTA injection was calculated. Subsequently, a chart audit was performed to estimate the number of patients with immune-altering conditions who had received IVTA during the period, and the incidence within this subgroup was calculated.

RESULTS:

Viral retinitis developed after IVTA injection in 3 patients, yielding an overall incidence of 3 in 736 or 0.41%. An estimated 334 injections were administered to patients with an immune-altering condition, including diabetes. All 3 of the patients in whom viral retinitis developed after IVTA injection possessed abnormal immune systems, yielding an incidence rate of 3 in 334 or 0.90% within this subgroup.

CONCLUSIONS:

Our high reported incidence for this potentially devastating complication can be attributed to multiple factors, including coexisting medical immunocompromising comorbidities, a higher dose with a longer duration of local immunosuppression in the vitreous, multiple injections, as well as previous viral retinitis. Caution with a high index of clinical suspicion and frequent follow-up is advised in patients receiving IVTA injection with potentially immune-altering conditions, even after apparent immune recovery.

• Authors: Ankur M Shah, Stephen F Oster, William R Freeman
• Journal: American journal of ophthalmology (Am J Ophthalmol) Vol. 149 Issue 3 Pg. 433-40.e1 (Mar 2010) ISSN: 1879-1891 [Electronic] United States
• PMID: 20172069 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: (c) 2010 Elsevier Inc. All rights reserved.

Chemical References

• Glucocorticoids
• Triamcinolone Acetonide

Topics

• Adult
• Aged
• Causality
• Cytomegalovirus Retinitis (epidemiology, etiology)
• Diabetes Mellitus, Type 2 (complications)
• Female
• Glucocorticoids (adverse effects)
• HIV Infections (complications)
• Herpes Zoster Ophthalmicus (epidemiology, etiology)
• Humans
• Incidence
• Injections
• Macular Edema (drug therapy)
• Male
• Middle Aged
• Ovarian Neoplasms (complications)
• Retinal Necrosis Syndrome, Acute (epidemiology, etiology)
• Retrospective Studies
• Risk Factors
• Triamcinolone Acetonide (adverse effects)
• Visual Acuity
• Vitreous Body