June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Clinical findings in triamcinolone associated maculopathy
Author Affiliations & Notes
  • Edith Reshef
    Robert Wood Johnson Medical School, New Brunswick, NJ
  • Howard F Fine
    Ophthalmology, Robert Wood Johnson Medical School, New Brunswick, NJ
  • jonathan prenner
    Ophthalmology, Robert Wood Johnson Medical School, New Brunswick, NJ
  • Sumit P Shah
    Ophthalmology, Robert Wood Johnson Medical School, New Brunswick, NJ
  • Daniel B Roth
    Ophthalmology, Robert Wood Johnson Medical School, New Brunswick, NJ
  • Hans E Grossniklaus
    Ophthalmology, Emory University School of Medicine, Atlanta, GA
  • Footnotes
    Commercial Relationships Edith Reshef, None; Howard Fine, Allergan, Inc. (C), Auris Surgical Robotics, Inc (C), Bausch & Lomb, Inc. (C), Genentech, Inc. (C), Regeneron Pharmaceuticals, Inc. (C); jonathan prenner, Genentech (C), Ophthotech (C), Panoptica (C), Regeneron (C); Sumit Shah, Allergan, Inc. (F), Genentech (C), Regeneron (F); Daniel Roth, Allergan, Inc. (C), Bayer Healthcare Inc (C), Forsight Labs V4 (P), Genentech (F), Ohr Pharmaceutical (C), Regeneron Pharmaceuticals (C), Thrombogenics (F); Hans Grossniklaus, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 2035. doi:
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    • Get Citation

      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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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

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.

 
Methods
 

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.

 
Results
 

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.

 
Conclusions
 

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.  

 
Triamcinolone crystals appear circular in distribution on fundoscopic exam
 
Triamcinolone crystals appear circular in distribution on fundoscopic exam

 
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