{"title":"A Case of Incidental and Uncomplicated Subretinal Triamcinolone Acetonide.","authors":"You Zhou, Rodney Guiseppi, Touka Banaee","doi":"10.1159/000539190","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Posterior subtenon injection of triamcinolone acetonide (PSTA) is commonly done to treat refractory cases of macular edema. Complications may arise from the procedure as well as from the use of the periocular steroid medications. Side effects include subconjunctival hemorrhage, progression of cataract, scleral perforation (resulting in subretinal, subhyaloid, or intravitreal injection of the drug), retinal detachment, ptosis, orbital fat prolapse, orbital abscess, infectious scleritis, ocular hypertension, and scleral abscess. Here we describe a case of inadvertent subretinal triamcinolone acetonide (TA) deposition from a PSTA procedure without any adverse vision-threatening outcomes.</p><p><strong>Case presentation: </strong>We report a patient who presented with a history of superior temporal left eye macula-off rhegmatogenous retinal detachment, which was successfully repaired with a scleral buckle (SB), pars plana vitrectomy, and gas placement. Due to persistent diplopia, the SB was removed after 1 year post-operatively. Due to the development of cystoid macular edema, a PSTA was performed after the patient failed topical steroids and NSAIDs. The procedure was halted early due to unexpected resistance during the injection. A dilated fundus exam showed the presence of subretinal triamcinolone acetonide. The patient was observed and found to have no complications with almost complete resolution of the triamcinolone acetonide after 3 months.</p><p><strong>Conclusion: </strong>In previous SB patients, it is important to highlight the risk of globe penetration, subretinal deposition of TA, formation of retinal breaks, or reopening of prior retinal breaks with posterior subtenon injection, which could have adverse effects on the local retina as well as the risk of retinal detachment.</p>","PeriodicalId":9635,"journal":{"name":"Case Reports in Ophthalmology","volume":"15 1","pages":"472-477"},"PeriodicalIF":0.6000,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11250497/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Case Reports in Ophthalmology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1159/000539190","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
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Abstract
Introduction: Posterior subtenon injection of triamcinolone acetonide (PSTA) is commonly done to treat refractory cases of macular edema. Complications may arise from the procedure as well as from the use of the periocular steroid medications. Side effects include subconjunctival hemorrhage, progression of cataract, scleral perforation (resulting in subretinal, subhyaloid, or intravitreal injection of the drug), retinal detachment, ptosis, orbital fat prolapse, orbital abscess, infectious scleritis, ocular hypertension, and scleral abscess. Here we describe a case of inadvertent subretinal triamcinolone acetonide (TA) deposition from a PSTA procedure without any adverse vision-threatening outcomes.
Case presentation: We report a patient who presented with a history of superior temporal left eye macula-off rhegmatogenous retinal detachment, which was successfully repaired with a scleral buckle (SB), pars plana vitrectomy, and gas placement. Due to persistent diplopia, the SB was removed after 1 year post-operatively. Due to the development of cystoid macular edema, a PSTA was performed after the patient failed topical steroids and NSAIDs. The procedure was halted early due to unexpected resistance during the injection. A dilated fundus exam showed the presence of subretinal triamcinolone acetonide. The patient was observed and found to have no complications with almost complete resolution of the triamcinolone acetonide after 3 months.
Conclusion: In previous SB patients, it is important to highlight the risk of globe penetration, subretinal deposition of TA, formation of retinal breaks, or reopening of prior retinal breaks with posterior subtenon injection, which could have adverse effects on the local retina as well as the risk of retinal detachment.
期刊介绍：
This peer-reviewed online-only journal publishes original case reports covering the entire spectrum of ophthalmology, including prevention, diagnosis, treatment, toxicities of therapy, supportive care, quality-of-life, and survivorship issues. The submission of negative results is strongly encouraged. The journal will also accept case reports dealing with the use of novel technologies, both in the arena of diagnosis and treatment. Supplementary material is welcomed. The intent of the journal is to provide clinicians and researchers with a tool to disseminate their personal experiences to a wider public as well as to review interesting cases encountered by colleagues all over the world. Universally used terms can be searched across the entire growing collection of case reports, further facilitating the retrieval of specific information. Following the open access principle, the entire contents can be retrieved at no charge, guaranteeing easy access to this valuable source of anecdotal information at all times.
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