INADVERTENT INTRAOCULAR TRIAMCINOLONE ACETONIDE INJECTION WITH FOVEAL MIGRATION AND PERSISTENT DEPOSITION
Muhammad Khairuddin M.A., Roslin Azni AA, Nor Fariza N. & Bastion M.L.C.
abstract
A 46-year-old woman presented with central scotoma following iatrogenic triamcinolone injection for treatment of upper lid chalazion 3 weeks prior. On examination her visual acuity was 3/60. Fundus examination revealed subfoveal deposition of triamcinolone acetonide (TA) and triangular shaped hypopigmented area presumably the site of inadvertent injection. Optical coherence tomography (OCT) noted hyperreflective material at fovea involving the outer retinal layers. Fundus fluorescein angiography (FFA) noted increase in fovea avascular zone (FAZ) and triangular shape staining at the supero-temporal quadrant. Following conservative treatment, at 6 months follow up vision remained unchanged and OCT showed reduction in hyperreflective material with better visualisation of retinal layers. This is the first reported case of retinal toxicity due to inadvertent intraocular injection of TA. This case highlights the importance of positioning to prevent foveal migration of TA, and the need for urgent vitrectomy to prevent vision impairment.
references
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12. Kato F, Nozaki M, Kato A, Yasukawa T. Retinal Microvascular Changes after Intravitreal Triamcinolone Acetonide in Diabetic Macular Edema. J Clin Med. 2023;12(10):3475. doi:10.3390/jcm12103475.
13. Balaratnasingam C, Inoue M, Ahn S, et al. Visual Acuity Is Correlated with the Area of the Foveal Avascular Zone in Diabetic Retinopathy and Retinal Vein Occlusion. Ophthalmology. 2016;123(11):2352-2367. doi:10.1016/j.ophtha.2016.07.008.
2. Couch SM, Bakri SJ. Intravitreal triamcinolone for intraocular inflammation and associated macular edema. Clin Ophthalmol Auckl NZ. 2009;3:41-47.
3. Giny S, Antonakis S, Almeida G. Iatrogenic retinal detachment secondary to inadvertent subretinal injection of triamcinolone during cataract surgery. Can J Ophthalmol J Can Ophtalmol. 2015;50:e108-e110. doi:10.1016/j.jcjo.2015.07.015..
4. Takeuchi M, Katagiri Y, Usui M. Residual triamcinolone acetonide in the macular hole after vitrectomy. Am J Ophthalmol. 2003;136(6):1174-1176. doi:10.1016/s0002-9394(03)00674-3.
5. Koto T, Inoue M, Shinoda K, Ishida S, Tsubota K. Residual crystals of triamcinolone acetonide in macular hole may prevent complete closure. Acta Ophthalmol Scand. 2007;85(8):913-914. doi:10.1111/j.1600-0420.2007.00965.x.
6. Kumar A, Sinha S, Gupta A. Residual triamcinolone acetonide at macular hole after vitreous surgery. Indian J Ophthalmol. 2010;58(3):232-234. doi:10.4103/0301-4738.62650.
7. Tran KD, Crane AM, Flynn HW. Management of inadvertent needle penetration resulting in subretinal triamcinolone acetonide and retinal detachment. Am J Ophthalmol Case Rep. 2018;10:288-289. doi:10.1016/j.ajoc.2018.04.010.
8. Yeung CK, Chan KP, Chan CKM, Pang CP, Lam DSC. Cytotoxicity of Triamcinolone on Cultured Human Retinal Pigment Epithelial Cells: Comparison with Dexamethasone and Hydrocortisone. Jpn J Ophthalmol. 2004;48(3):236-242. doi:10.1007/s10384-003-0053-8.
9. Chang YS, Wu CL, Tseng SH, Kuo PY, Tseng SY. Cytotoxicity of Triamcinolone Acetonide on Human Retinal Pigment Epithelial Cells. Invest Ophthalmol Vis Sci. 2007;48(6):2792-2798. doi:10.1167/iovs.06-1146.
10. Yu SY, Damico FM, Viola F, D’amico DJ, Young LH. RETINAL TOXICITY OF INTRAVITREAL TRIAMCINOLONE ACETONIDE: A Morphological Study. RETINA. 2006;26(5):531.
11. Bhisitkul RB, Winn BJ, Lee OT, et al. Neuroprotective Effect of Intravitreal Triamcinolone Acetonide against Photoreceptor Apoptosis in a Rabbit Model of Subretinal Hemorrhage. Invest Ophthalmol Vis Sci. 2008;49(9):4071-4077. doi:10.1167/iovs.08-1892.
12. Kato F, Nozaki M, Kato A, Yasukawa T. Retinal Microvascular Changes after Intravitreal Triamcinolone Acetonide in Diabetic Macular Edema. J Clin Med. 2023;12(10):3475. doi:10.3390/jcm12103475.
13. Balaratnasingam C, Inoue M, Ahn S, et al. Visual Acuity Is Correlated with the Area of the Foveal Avascular Zone in Diabetic Retinopathy and Retinal Vein Occlusion. Ophthalmology. 2016;123(11):2352-2367. doi:10.1016/j.ophtha.2016.07.008.