Triamcinolone-Associated Crystalline Maculopathy

Abstract

To describe the findings of a new crystalline maculopathy exclusively affecting individuals who have previously received intravitreous triamcinolone acetonide injections. Methods: In a retrospective, observational, noncomparative case series, 21 eyes of 13 patients referred over a 9-year period were identified as having a characteristic crystalline maculopathy. Each patient underwent detailed historical questioning and comprehensive ocular evaluation, including formal retinal examination, fundus photography, fluorescein angiography, and optical coherence tomography. Results: Each of the 21 eyes was treated with intravitreous triamcinolone (preserved in all but 2 eyes) for macular edema (18 eyes due to diabetes, 2 due to pseudophakic cystoid macular edema, and 1 due to a vein occlusion). The crystals were superficial, refractile, white or yellow-Author Affiliations are listed at the end of this article.

Clinical trials on corticosteroids for diabetic macular edema

“…The most common side-effects of IVTA are steroidinduced elevation of IOP varying from 20% to 70%, cataract in about 15%-20%, and crystalline maculopathy [18,19,21,22,52,[66][67][68][69][70][71] . Other complications include endophthalmitis, intraocular hemorrhages, detachment of the retina [52,70,[71][72][73][74] .…”

“…Other complications include endophthalmitis, intraocular hemorrhages, detachment of the retina [52,70,[71][72][73][74] . In order to reduce the risks , complications and frequent dosing of intravitreal steroid , intravitreal steroid sustained-release implants have been developed.…”

Peristence of triamcinolone crystals after intra-vitreal injection: Benign crystalline hyaloidopathy

“…[2] A recent study has identified intra-vitreal triamcinolone acetonide injections, both preserved and preservative-free, as a cause of crystalline retinal deposits. [1] Our case report also identifies triamcinolone crystal deposition, all on the posterior hyaloidal surface. With follow-up now extending greater than 6 years, no functional toxic effects have been noted in our patient.…”

“…In our case and the previous series no adverse visual effect or structural changes had been noted. [1] We suggest the term ‘drug-induced benign hyaloidopathy’ and recommend this to be included as a differential diagnosis of crystalline maculopathy and asteroid hyalosis.…”

“…Recently intra-vitreal triamcinolone injection has been reported to induce a similar clinical picture without any adverse functional or structural effects. [1] We report a case of persistence of triamcinolone crystals with 6 years’ follow-up resembling the clinical picture of crystalline maculopathy.…”