Viral Retinitis After Intravitreal Triamcinolone Injection in Patients With Predisposing Medical Comorbidities

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)...

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Bibliographic Details
Published in:American journal of ophthalmology 2010-03, Vol.149 (3), p.433-440.e1
Main Authors: Shah, Ankur M, Oster, Stephen F, Freeman, William R
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Biotechnology
Causality
Colleges & universities
Cytomegalovirus Retinitis - epidemiology
Cytomegalovirus Retinitis - etiology
Diabetes
Diabetes Mellitus, Type 2 - complications
Female
Glucocorticoids - adverse effects
Herpes viruses
Herpes Zoster Ophthalmicus - epidemiology
Herpes Zoster Ophthalmicus - etiology
HIV Infections - complications
Humans
Incidence
Infectious diseases
Injections
Macular degeneration
Macular Edema - drug therapy
Male
Medical sciences
Middle Aged
Miscellaneous
Ophthalmology
Ovarian Neoplasms - complications
Photodynamic therapy
Polymerase chain reaction
Retina
Retinal Necrosis Syndrome, Acute - epidemiology
Retinal Necrosis Syndrome, Acute - etiology
Retinopathies
Retrospective Studies
Risk Factors
Steroids
Triamcinolone Acetonide - adverse effects
Viral diseases
Visual Acuity
Vitreous Body
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Summary: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.
ISSN:0002-9394
1879-1891
DOI:10.1016/j.ajo.2009.10.019