Jacobs Retina Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California 92093, USA.
Am J Ophthalmol. 2010 Mar;149(3):433-40.e1. doi: 10.1016/j.ajo.2009.10.019.
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.
Retrospective, observational case series.
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.
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.
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.
回顾单中心玻璃体腔类固醇注射后发生病毒性视网膜炎的病例，估计其发病率，并提出发生的危险因素。
回顾性、观察性病例系列。
2002 年 9 月至 2008 年 11 月，3 位视网膜专家在一家学术医疗中心的诊室和手术室共进行了 736 例曲安奈德玻璃体腔注射。纳入标准为在该期间内有 1 次或多次玻璃体腔注射曲安奈德的病史。计算玻璃体腔注射曲安奈德后发生病毒性视网膜炎的总发生率。随后，对病历进行审核，估计在该期间内接受玻璃体腔注射曲安奈德的免疫改变患者的数量，并计算该亚组内的发生率。
3 例患者在玻璃体腔注射曲安奈德后发生病毒性视网膜炎，总发生率为 736 例中的 3 例，即 0.41%。有免疫改变疾病的患者接受了估计 334 次注射，包括糖尿病。在玻璃体腔注射曲安奈德后发生病毒性视网膜炎的 3 例患者均有异常免疫系统，该亚组的发生率为 334 例中的 3 例，即 0.90%。
我们报告的这种潜在破坏性并发症的发生率较高，可归因于多种因素，包括并存的医学免疫抑制合并症、玻璃体内更长时间局部免疫抑制的更高剂量、多次注射以及先前的病毒性视网膜炎。对于接受可能改变免疫的玻璃体腔注射的患者，即使在免疫恢复后，也应保持高度的临床怀疑指数并进行频繁随访。
