Injection intravitréenne : évaluation rétrospective de la technique et des complications d’une série de 2028 injections

Résultats Deux mille vingt-huit injections intra-vitréennes ont été réalisées principalement pour DMLA (n = 1 192) ou œdème maculaire secondaire au diabète ou à une occlusion veineuse (n = 41). Les produits injectés étaient initialement la triamcinolone 4 mg (339 injections), puis le pegaptanib sodium 0,3 mg (1 179 injections) et le ranibizumab 0,3 mg (497 injections). Les patients ont reçu de 1 à 27 injections intravitréennes par œil. Les principales complications observées étaient par ordre de gravité : endophtalmie (2 après triamcinolone, 0,1 % du groupe total), pseudo-endophtalmie (2 après triamcinolone, 0,1 % du groupe total), hypertonie (7,69% du groupe total, 13,78 % après triamcinolone, 3,56 % après pegaptanib) dont 5 cas d’hypertonie aiguë avec perte de la perception lumineuse transitoire après ranibizumab, cataracte (0,44 % du groupe total), trou maculaire (1 cas après triamcinolone). Aucun cas de décollement de rétine ni de complication générale n’est survenu. Discussion Les principales complications sont survenues après injections de triamcinolone non filtrée. L’incidence des endophtalmies a considérablement régressé avec l’expérience et l’utilisation d’une salle dédiée. Les injections itératives sont localement bien supportées. Conclusion Dans le respect des conditions d’asepsie, le traitement par injection intra-vitréenne semble être bien supporté à court et long terme. Objective To observe the tolerance of repeated intravitreous injections over the short and long term and to analyze their complications. Patients and methods The clinical records of consecutive patients having one or several intravitreous injections between 2002 and 2007 were evaluated, for all indications except the treatment of endophthalmitis. Results 2028 intravitreous injections were performed, mainly for age-related macular degeneration ( n =1 192) or macular edema secondary to diabetes mellitus or retinal vein occlusion ( n =41). The injected drug was triamcinolone acetonide 4 mg (339 injections), pegaptanib sodium 0.3 mg (1179 injections), and ranibizumab 0.3 (497 injections). The patients received 1-27 intravitreous injections per eye. The main complications were endophthalmitis (two after triamcinolone, 0.1% of the total group), pseudoendophthalmitis (two after triamcinolone, 0.1% of the total group), hypertony (7.69% of the total group, 13.78% after triamcinolone, 3.56% after pegaptanib, 1.21% after ranibizumab), including five cases of acute hypertony with transient light perception loss after ranibizumab, cataract (0.44% of total group), and macular hole (one patient after triamcinolone). No case of retinal detachment nor systemic complication was observed. Discussion Most of the complications were observed with the use of nonfiltered triamcinolone. The incidence of endophtalmitis was considerably lower with increased experience and the use of a dedicated room for the injections. Repeated injections were locally well tolerated. Conclusion With the strict respect of asepsis rules, intravitreous injection seems well tolerated over the short and long term. Mots-clés Injection intra-vitréenne DMLA trou maculaire endophtalmie hypertonie oculaire cataracte œdème maculaire diabétique œdème maculaire occlusion veineuse rétinienne triamcinolone ranibizumab pegaptanib sodium Key-words Intravitreous injection AMD macular hole endophtalmitis intraocular pressure cataract diabetic macular edema macular edema retinal vein occlusion triamcinolone ranibizumab pegaptanib Références 1. T. Sakamoto H. Enaida T. Kubota M. Nakahara K. Yamakiri T. Yamashita Incidence of acute endophtalmitis after triamcinolone assisted pars plana vitrectomy Am J Ophtalmol 138 2004 137 138 2. D.B. Roth J. Chieh M.J. Spirn S.N. Green D.L. Yarian N.A. Chaudhry Non infectious endophtalmitis associated with intravitrel triamcinolone injection Arch Ophthalmol 121 2003 1279 1282 3. M.L. Nelson M.T. 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