Materials and Methods: During prospective non-randomized evaluation of case series, 100 patients received single IVT-TA injection for various purposes between December 2003 and July 2004. Forty-six percent of patients were male and 54 % female with an age range of 39 to 77 (mean: 64,37±9,13). Fifty-five percent of these patients were diabetic with macular edema. Other indications for IVT-TA injection were central retinal vein occlusion (CRVO) 11 %, hemispheric retinal vein occlusion (HRVO) 5 %, branch retinal vein occlusion (BRVO) with macular edema 18 %, refractory pseudophakic cystoid macular edema (CME) 11 %. Each patient was questioned and examined on postoperative first and 3rd days for the presence of pain, discomfort, loss of visual acuity, inflammatory signs of anterior and posterior chamber. The examinations were repeated at first and 2nd weeks also. Follow up periods were 3-10 months (mean: 6.93±1,89)

Results: During the follow up of the patients we encountered 4 cases of endophthalmitis among which only one yielded culture positivity for staphylococcal species. This patient admitted with the worsening of the vision and development of pain and discomfort of the treated eye on the 8th postoperative day. This patient was a 65 years old female with diabetes. The ocular examination was consistent with the diagnosis of endophthalmitis. The presence of corneal edema, hypopion and vitritis with loss of fundus visibility led us to take samples of anterior chamber and vitreous for microbiologic analysis. Immediate IVT antibiotic administration was accomplished and after 2 days -after receiving the positive results of culture- pars plana vitrectomy was done. The visual acuity of this patient was 0.05 at the end of 3rd month. The other cases of endophthalmitis were detected on postoperative 2-3 days with relatively milder patient complaints of ocular discomfort and mild pain. Hypopion and vitritis were also present but fundus could be observed though the details were obscure. Vitreous aspirates were taken for microbiologic culture which revealed negative results. Meanwhile , the patients were hospitalized and examined every hour for worsening of the symptoms and signs. These cases were , however, stable and no agressive treatment was indicated. The signs and symptoms subsided within 36-48 hours with topical antibiotic and steroid treatment.

Conclusion: Endophthalmitis, which is one of the most feared complications of ophthalmic invasive procedures, may also occur after IVT-TA injection. It is very important to provide aseptic conditions before injection in order to avoid microbial contamination. Majority of these patients are diabetic who are somewhat immunocompromised especially when they do not have adequte metabolic control. Injection should be postponed until the metabolic status is normalised. The additive chemicals within the commercial preparate seem to be responsible for presumed noninfectious endophthalmitis observed in some cases. Elimination of these substances would decrease the incidence of endophthalmitis cases. The most important point is to differentiate infectious from noninfectious endophthalmitis, thus to give a desicion of additional invasive procedures or noninvasive follow up and treatment. Keywords : Triamcinolone acetonide, endophthalmitis, sterile endophthalmitis, pseudoendophthalmitis