To describe a crystalline retinopathy observed in patients greater than 1 year after intravitreal injection of triamcinolone acetonide (IVTA).
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.
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.
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: firstname.lastname@example.org
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.