Mild toxic anterior segment syndrome mimicking delayed onset toxic anterior segment syndrome after cataract surgery.

Toxic anterior segment syndrome (TASS) is an acute sterile postoperative anterior segment infl ammation that may occur after anterior segment surgery. I report herein a case that developed mild TASS in one eye after bilateral uneventful cataract surgery, which was masked during early postoperative period under steroid eye drop and mimicking delayed onset TASS after switching to weaker steroid eye drop.

Batch-related sterile endophthalmitis following intravitreal injection of bevacizumab.

Background: To report a series of patients with sterile endophthalmitis after intravitreal bevacizumab (IVB) injection from 2 different batches of bevacizumab. Materials and Methods: Records of 11 eyes with severe inflammation after IVB injections from two different batches (7 eyes from one and 4 from the other) on two separate days were evaluated. Fifteen eyes of 15 patients in one day were treated with one batch and 18 eyes of 17 patients were treated another day using another batch injected for different retinal diseases. Each batch was opened on the day of injection. We used commercially available bevacizumab (100 mg/4 ml) kept at 4°C. Severe cases with hypopyon were admitted to the ward and underwent anterior chamber and vitreous tap for direct smear and culture. Results: Pain, redness and decreased vision began after 11-17 days. All had anterior chamber and vitreous reactions and 5 had hypopyon. Antibiotics and corticosteroids were initiated immediately, but the antibiotics were discontinued after negative culture results. Visual acuity returned to pre-injection levels in 10 eyes after 1 month and only in one eye pars plana vitrectomy was performed. Mean VA at the time of presentation with inflammation (1.76 ± 0.78 logMAR) decreased significantly (P = 0.008) compared to the initial mean corrected VA (1.18 ± 0.55 logMAR); however, final mean corrected VA (1.02 ± 0.48 logMAR) improved in comparison with the baseline but not to a significant level (P = 0.159). Conclusions: We report a cluster of sterile endophthalmitis following intravitreal injection of bevacizumab from the same batch of bevacizumab that has a favorable prognosis.

Complications after Intravitreal Triamcinolone Acetonide Injection: Incidence and Risk Factors

PURPOSE: To reduce complications and provide proper management for better clinical outcomes in the treatment of macular edema through a large-scale analysis of the incidence and risk factors for complications of intravitreal triamcinolone injection. METHODS: The medical records of 490 eyes that received intravitreal triamcinolone (4.0 mg) injection for treatment of macular edema caused by various diseases were retrospectively reviewed, and relevant parameters were included in a multivariate regression model. RESULTS: Vitrectomized (p < 0.001) and pseudophakic (p = 0.054) eyes were less likely to exhibit an intraocular pressure increase, but glaucoma (p < 0.001) and young age (p = 0.073) were found to be significant risk factors for this complication. Vitrectomized eyes (p = 0.011), diabetic macular edema (p < 0.001), secondary ocular hypertension (p = 0.029) and old age (p = 0.059) were associated with cataract progression. Three consecutive case of sterile endophthalmitis, which differs from bacterial endophthalmitis in clinical course and prognosis, occurred during the same period. CONCLUSIONS: Risk factors and the incidence of complications after intravitreal triamcinolone injection should be evaluated through regular follow-up evaluation to ensure proper management and a better prognosis.

Clinical Manifestations of Presumed Sterile Endophthalmitis After Intravitreal Triamcinolone Injection

PURPOSE: To evaluate the distinguishing characteristics that may assist in the clinical diagnosis of sterile endophthalmitis from intravitreal triamcinolone injection. METHODS: From January 2005 to June 2006, the medical records of 163 eyes that received intravitreal triamcinolone injection were reviewed. In 5 eyes of 5 patients who complained of decreasing vision and mild ocular pain within three days after injection, slit lamp bimicroscopy revealed hypopyon, anterior chamber reaction, and vitritis. We analyzed clinical pictures retrospectively. RESULTS: Intravitreal triamcinolone injections were performed for diabetic macular edema in 4 patients and for panuveitis in 1 patient with Behcet's disease. Pseudophakia was found in all five eyes. Inflammations in three eyes resolved with topical and oral antibiotics within 13 days, and the other two patients were treated with a vitreous culture and intravitreal antibiotic injection. However, vitreous tap showed no evidence of endophthalmitis, and inflammation resolved within the same period. CONCLUSIONS: Presumed sterile endophthalmitis presents within 3 days after intravitreal triamcinolone injection and may be accompanied by decreased vision and ocular discomfort, although it is characterized by no distinct ocular pain. The symptoms and ocular inflammation resolved quickly within 13 days with a favorable visual outcome. Inflammations in three eyes resolved without surgical intervention, so it may be necessary to closely observe clinical manifestations before assuming that the eye is suffering from infectious endophthalmitis.

Presumed Noninfectious Endophthalmitis after Intravitreal Injection of Triamcinolone Acetonide

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.