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Infectious Uveitis after Local Steroid and/or Methotrexate Injections at A Tertiary Referral Center in New Zealand: A Case Series.

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  • Additional Information
    • Source:
      Publisher: Informa Healthcare Country of Publication: England NLM ID: 9312169 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1744-5078 (Electronic) Linking ISSN: 09273948 NLM ISO Abbreviation: Ocul Immunol Inflamm Subsets: MEDLINE
    • Publication Information:
      Publication: London : Informa Healthcare
      Original Publication: Buren, The Netherlands : Aeolus Press, c1993-
    • Subject Terms:
      Chorioretinitis*/complications ; Cytomegalovirus Retinitis*/diagnosis ; Eye Infections, Bacterial*/complications ; Uveitis*/complications ; Uveitis*/diagnosis ; Uveitis*/drug therapy; Aged ; Glucocorticoids/adverse effects ; Humans ; Intravitreal Injections ; Methotrexate/adverse effects ; Middle Aged ; New Zealand/epidemiology ; Retrospective Studies ; Tertiary Care Centers ; Triamcinolone Acetonide
    • Abstract:
      Aim: Infectious uveitis is one of the most visually devastating causes of uveitis worldwide and accounts for 19.6% of all cases of uveitis in New Zealand. With the burgeoning use of intravitreal injections, there has been a commensurate increase in the number of injection-related complications and reports of infectious uveitis following their administration in recent years. We present a case series of four patients with infectious uveitis after local injections.
      Method: We retrospectively reviewed the data of four patients (mean age, 67.25 ± 7.58 years) who presented to the department of ophthalmology at Auckland District Health Board with infectious uveitis which occurred or worsened after local triamcinolone acetonide (TA) and/or methotrexate (MTX) injections.
      Results: Three patients received local TA and one patient received intravitreal MTX. All patients were immunosuppressed prior to treatment. Two patients had toxoplasma chorioretinitis which worsened with local TA and one patient developed cytomegalovirus (CMV) retinitis after intravitreal TA. The last patient had syphilis retinopathy which worsened with intravitreal MTX. There were atypical presentations, as demonstrated by a case of presumed birdshot chorioretinopathy flare which tested positive for toxoplasma chorioretinitis with polymerase chain reaction (PCR).
      Conclusion: Uveitis due to infectious etiologies needs to be carefully excluded prior to the use of local steroid and/or methotrexate injections. Disease presentations may be atypical in the presence of marked immunosuppression following local therapy. Polymerase chain reaction (PCR) can play an important role in the diagnosis in this setting.
    • Contributed Indexing:
      Keywords: Infectious uveitis; intravitreal; methotrexate; triamcinolone
    • Accession Number:
      0 (Glucocorticoids)
      F446C597KA (Triamcinolone Acetonide)
      YL5FZ2Y5U1 (Methotrexate)
    • Publication Date:
      Date Created: 20210401 Date Completed: 20221017 Latest Revision: 20221017
    • Publication Date:
      20250114
    • Accession Number:
      10.1080/09273948.2020.1860230
    • Accession Number:
      33792480