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Fine, Howard F., MD, MHSc*; Reshef, Edith R., MD*; Prenner, Jonathan L., MD*; Shah, Sumit P., MD*; Grossniklaus, Hans E., MD, MBA; Roth, Daniel B., MD*

doi: 10.1097/IAE.0000000000002007
Original Study: PDF Only

Purpose: To describe a crystalline retinopathy observed in patients greater than 1 year after intravitreal injection of triamcinolone acetonide (IVTA).

Methods: A retrospective, interventional, noncomparative, single-center case series of patients who received IVTA and developed subsequent crystalline retinopathy lasting greater than 1 year after injection.

Results: Eighteen eyes of 16 patients in which preretinal crystals were observed >1 year after IVTA were included in the study, with a mean follow-up (range) of 5.8 years (1.1–9.2) after IVTA. The crystals were refractile, not visible on fluorescein nor indocyanine green angiography, exhibited slow dissolution and movement, and were occasionally distributed in a circular fashion. Optical coherence tomography confirmed the preretinal and/or subhyaloid location of crystals.

Conclusion: Macular crystals can persist for years after IVTA. The crystals localize to the preretinal or subhyaloid space, are angiographically silent, can exhibit slow dissolution and movement, may be distributed in a circular fashion reflecting the bursa premacularis, and appear nonpathologic.

*Department of Ophthalmology, Rutgers—Robert Wood Johnson Medical School, New Brunswick, New Jersey; and

Department of Ophthalmology, School of Medicine, Emory University, Atlanta, Georgia.

Reprint requests: Howard F. Fine, MD, MHSc, Department of Ophthalmology, Rutgers—Robert Wood Johnson Medical School, 10 Plum Street, Suite 600, New Brunswick, NJ 08901; e-mail:

Presented in part at the American Society of Retina Specialists Annual Meeting, Vancouver, Canada, August 31, 2010.

H. F. Fine, S. P. Shah: Genentech (C), Regeneron (C), Allergan (C), Alimera (C). J. L. Prenner: Ophthotech (C, O), Panoptica (C, O), Genentech (C), Regeneron (C), Alcon (C), DSMB member of Neurotech. D. B. Roth: Genentech (C), Regeneron (C), Ohr (C, O). The remaining authors have no financial/conflicting interests to disclose.

The off-label use of intravitreal triamcinolone acetonide is discussed in this manuscript.

© 2019 by Ophthalmic Communications Society, Inc.