Occurrence of infectious uveitis following local triamcinolone and/or methotrexate injections: A case series

Aaron Ong, Joanne Sims, Rachael Niederer

Meeting:  2022 RANZCO


Date:      -

Session Title: UVEITIS

Session Time:      -

Purpose: 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 fol- lowing 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) retini- tis after intravitreal TA. The last patient had syphilis reti- nopathy 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.

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 can play an important role in the diagnosis in this setting.