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BMC Ophthalmology

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Open Access 01-12-2018 | Case report

Vitreous opacities after intravitreal triamcinolone injection- a case report

Authors: Dhanashree Ratra, Vineet Ratra, Haard Shah

Published in: BMC Ophthalmology | Issue 1/2018

Abstract

Background

We report occurrence of peculiar tiny white thread like vitreous opacities after intravitreal triamcinolone injection. These persisted without any change for over a year. We ascribe them to aggregation of triamcinolone crystals due to the purification methods.

Case presentation

Seven patients (8 eyes) with macular edema developed tiny whitish thread like opacities in the vitreous 2–3 months after undergoing an intravitreal injection of triamcinolone acetonide preparation containing benzyl alcohol as preservative. These opacities persisted unchanged for more than a year. The follow up ranged from 91 to 425 days. Vitreous tap was done in one patient which was negative for infection. All patients initially showed improvement but needed re-treatment for recurrence. One patient developed steroid induced rise in intraocular pressure. Microscopic examination of the drug revealed large string like aggregates of triamcinolone crystals.

Conclusions

We hypothesize the possibility of aggregation of triamcinolone crystals into string like structures probably due to the purification methods used during manufacture which led to these thread like opacities in the vitreous.

Zhang XL, Chen J, Zhang RJ, Wang WJ, Zhou Q, Qin XY. Intravitreal triamcinolone versus intravitreal bevacizumab for diabetic macular edema: a meta-analysis. Int J Ophthalmol. 2013;6(4):546–52.PubMedPubMedCentral

Elman MJ, Bressler NM, Qin H, Beck RW, Ferris FL 3rd, Friedman SM, Glassman AR, Scott IU, Stockdale CR, Sun JK, Diabetic Retinopathy Clinical Research Network. Expanded 2-year follow-up of ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema. Ophthalmology. 2011;118(4):609–14.CrossRefPubMedPubMedCentral

Diabetic Retinopathy Clinical Research Network. A randomized trial comparing intravitreal triamcinolone acetonide and focal/grid photocoagulation for diabetic macular edema. Ophthalmology. 2008;115(9):1447–9. 1449.e1–10CrossRefPubMedCentral

Jager RD, Aiello LP, Patel SP, Cunningham ET Jr. Risks of intravitreous injection: a comprehensive review. Retina. 2004;24:676–98.CrossRefPubMed

Vedantham V, Kolluru C, Ramasamy K. Persistent depot of triamcinolone acetonide after a single intravitreal injection. Indian J Ophthalmol. 2005;53:65–6.CrossRefPubMed

Hosseini H, Anvari-Ardakani HR, Karanjam MA, Farvardin M, Nowroozizadeh S. Ultrasonographic pictures of intravitreal triamcinolone acetonide. Eur J Ophthalmol. 2009;19(2):263–7.CrossRefPubMed

Nelson ML, Tennant MT, Sivalingam A, Regillo CD, Belmont JB, Martidis A. Infectious and presumed non-infectious endophthalmitis after intravitreal triamcinolone acetonide injection. Retina. 2003;23(5):686–91.CrossRefPubMed

Moshfeghi AA, Scott IU, Flynn HW Jr, Puliafito CA. Pseudohypopyon after intravitreal triamcinolone acetonide injection for cystoid macular edema. Am J Ophthalmol. 2004;138(3):489–92.CrossRefPubMed

Sutter FKP, Gillies MC. Pseudo-endophthalmitis after intravitreal injection of triamcinolone. Br J Ophthalmol. 2003;87(8):972–4.CrossRefPubMedPubMedCentral

10.

Hida T, Chandler D, Arena JE, Machemer R. Experimental and clinical observations of the intraocular toxicity of commercial corticosteroid preparations. Am J Ophthalmol. 1986;101(2):190–5.CrossRefPubMed

11.

Scott IU, Ip MS, VanVeldhuisen PC, Oden NL, Blodi BA, Fisher M, Chan CK, Gonzalez VH, Singerman LJ, Tolentino M. SCORE study research group a randomized trial comparing the efficacy and safety of intravitreal triamcinolone with standard care to treat vision loss associated with macular edema secondary to branch retinal vein occlusion: the standard care vs corticosteroid for retinal vein occlusion (SCORE) study report 6. Arch Ophthalmol. 2009;127(9):1115–28.CrossRefPubMedPubMedCentral

12.

Kleinman ME, Westhouse SJ, Ambati J, Pearson PA, Halperin LS. Triamcinolone crystal size. Ophthalmology. 2010;117(8):1654.CrossRefPubMedPubMedCentral

13.

Szurman P, Kaczmarek R, Jaissle GB, Grisanti S, Lüke M, Spitzer MS, Heide PE, Bartz-Schmidt KU. Influence of different purification techniques on triamcinolone yield and particle size spectrum. Graefes Arch Clin Exp Ophthalmol. 2007;245(5):689–96.CrossRefPubMed

14.

Moshfeghi AA, Nugent AK, Nomoto H, Sanislo SR, Kitchens JW, Moshfeghi DM. Triamcinolone acetonide preparations: impact of crystal size on in vitro behavior. Retina. 2009;29(5):689–98.CrossRefPubMed

15.

Spitzer MS, Mlynczak T, Schultheiss M, Rinker K, Yoeruek E, Petermeier K, Januschowski K, Szurman P. Preservative-free triamcinolone acetonide injectable suspension versus “traditional” triamcinolone preparations: impact of aggregate size on retinal biocompatibility. Retina. 2011;31(10):2050–7.CrossRefPubMed

Title: Vitreous opacities after intravitreal triamcinolone injection- a case report
Authors: Dhanashree Ratra
Vineet Ratra
Haard Shah
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Ophthalmology / Issue 1/2018
Electronic ISSN: 1471-2415
DOI: https://doi.org/10.1186/s12886-018-0818-y

At a glance: The STEP trials

Springer Medicine

Vitreous opacities after intravitreal triamcinolone injection- a case report

Abstract

Background

Case presentation

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Case presentation

Conclusions

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