Purpose: To describe the clinical presentation, diagnosis, and management of presumed sterile endophthalmitis following combined intravitreal triamcinolone acetonide and anti–vascular endothelial growth factor (VEGF) therapy in patients with chronic diabetic macular edema. Case presentation: In a single operative theatre setting, eight patients received intravitreal anti-VEGF injections and three patients received a combination of anti-VEGF (ranibizumab) with triamcinolone acetonide (Aurocort). All injections were performed under sterile precautions. All three patients who received combined therapy developed sudden-onset of symptoms within 24 hours post-injection, presenting with severe pain, redness, and marked vision loss. Initial visual acuity ranged from hand motion to perception of light. Clinical findings included lid and periorbital edema, severe conjunctival congestion, corneal edema with Descemet membrane folds, anterior chamber cells and flare, sluggish pupils, and dense vitreous inflammation. Vitreous tap and core vitrectomy with intravitreal vancomycin, ceftazidime, and dexamethasone were performed in two patients. Cultures from the vitreous, triamcinolone vial, and ranibizumab vial were negative for organisms. Final visual acuity improved to 6/9–6/12 in treated patients; one patient was lost to follow-up. Conclusions: Presumed sterile endophthalmitis may occur after combined intravitreal triamcinolone. Early diagnosis, prompt vitrectomy, and intravitreal antibiotics with steroids are critical for favourable outcomes. The visual prognosis is generally good and depends largely on timely intervention and the status of the underlying retinal disease.
Rath et al. (2026) studied this question.