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Edith Reshef, Howard F Fine, jonathan prenner, Sumit P Shah, Daniel B Roth, Hans E Grossniklaus; Clinical findings in triamcinolone associated maculopathy. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2035.
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The differential diagnosis for crystalline retinopathy is broad, including toxic, genetic, and degenerative causes. This report describes a series of patients with retinal crystals observed greater than one year following intra-vitreal injection of triamcinolone acetonide.
In this retrospective, interventional, non-comparative, single-center case series, patients were identified who underwent intra-vitreal injection of triamcinolone acetonide with subsequent observation of crystalline retinopathy greater than 1 year following injection. Clinical charts, fundus photography, and optical coherence tomography (OCT) were reviewed.
Fifteen eyes of thirteen patients with a mean age of 67 were included in the study. The underlying diagnosis was: diabetic macular edema (5 eyes), branch vein occlusion (3 eyes), macular edema (10 eyes) and choroidal neovascularization (3 eyes). The logMAR acuity improved from 0.898 at baseline to 0.747 at one year (Snellen 20/158 to 20/112). Pre-retinal crystals were observed between 1.0 and 3.1 years following intravitreal injection. The crystals were refractile, angiographically silent, exhibited slow dissolution and movement, and some were circular in distribution around the pre-macular bursa. OCT confirmed the pre-retinal location of crystals.
Pre-retinal crystals may persist for years following intravitreal injection of triamcinolone acetonide in humans. These crystals appear to be non-pathologic, are angiographically silent, visualized on OCT, mobile, and often circular in distribution as they appear to be sequestered to the pre-macular bursa. Clinicians ought to consider remote triamcinolone injection in the differential diagnosis of patients with retinal crystals.
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