Ratra D, Ratra V, Shah H. Vitreous opacities after intravitreal triamcinolone injection- a case report.
BMC Ophthalmol 2018;
18:145. [PMID:
29925346 PMCID:
PMC6011592 DOI:
10.1186/s12886-018-0818-y]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 06/11/2018] [Indexed: 11/12/2022] Open
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.
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