• Users Online: 68082
  • Home
  • Print this page
  • Email this page

   Table of Contents      
BRIEF COMMUNICATION
Year : 2013  |  Volume : 61  |  Issue : 4  |  Page : 182-183

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


1 College of Medicine, University of Central Florida, Orlando, FL, USA
2 College of Medicine, University of Central Florida; Department of Veterans Affairs, Orlando, FL; College of Medicine, Howard University, Washington, DC; College of Medicine, University of South Florida, Tampa, FL; College of Medicine, Florida State University, Tallahassee, FL, USA
3 Department of Veterans Affairs, Orlando, FL, USA

Date of Submission16-Aug-2011
Date of Acceptance26-Oct-2012
Date of Web Publication17-May-2013

Correspondence Address:
Saad Shaikh
UCF College of Medicine, Medical Education Building, 6850 Lake Nona Blvd, Suite 412B, Orlando, FL 32827
USA
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.112166

Rights and Permissions
  Abstract 

We report a case of unusually long persistence of triamcinolone crystals after intra-vitreal injection. Crystals were noted on fundus examination predominantly confined to the posterior pole. Optical coherence tomography localized the crystals to the posterior hyaloidal surface. Over 6 years of follow-up the patient has retained good visual acuity and no observable changes in the retina. As the condition clinically resembles both crystalline maculopathy and asteroid hyalosis, we suggest the term 'drug-induced benign crystalline hyaloidopathy'.

Keywords: Asteroid hyalosis, crystalline, crystalline hyaloidpathy, crystalline maculopathy, clinically significant macular edema, diabetic, hyaloid, retinopathy, triamcinolone, unilateral


How to cite this article:
Zarifa R, Shaikh S, Kester E. Peristence of triamcinolone crystals after intra-vitreal injection: Benign crystalline hyaloidopathy. Indian J Ophthalmol 2013;61:182-3

How to cite this URL:
Zarifa R, Shaikh S, Kester E. Peristence of triamcinolone crystals after intra-vitreal injection: Benign crystalline hyaloidopathy. Indian J Ophthalmol [serial online] 2013 [cited 2024 Mar 29];61:182-3. Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?2013/61/4/182/112166

Differential diagnosis of crystalline maculopathy and retinopathy consists of only a handful of conditions. Typically, the clinical picture demonstrates multiple deposits involving the macular area with variable effect on visual acuity. 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.


  Case Report Top


A 59-year-old asymptomatic diabetic male was referred to our retinal service with presumed diagnosis of asteroid hyalosis. The patient had undergone laser treatment and intravitreal preserved triamcinolone acetonide injection for clinically significant diabetic macular edema in the right eye 4 years previously. Anterior segment examination revealed a posterior chamber intraocular lens with no other remarkable findings. Mild non-proliferative diabetic retinal changes were present in both eyes. The right eye showed focal laser scars in the macula and several shiny refractile crystalline deposits [Figure 1]. Optical coherence tomography localized these deposits to the posterior hyaloid [Figure 2]. These deposits were isofluorescent and not associated with specific angiographic abnormalities [Figure 3]. The patient has been followed for two additional years without any change in the visual acuity or status of the macula. Although a posterior vitreous separation has not developed, the crystals have been observed to migrate slowly in distribution.
Figure 1: A fundus photograph of the right eye demonstrating small pre-retinal crystals concentrated in the macula, although peripheral crystals are noted (arrow)

Click here to view
Figure 2: Para-foveal optical coherence tomography scan of the right eye demonstrating triamcinolone crystal deposits on the posterior hyaloid surface (arrow)

Click here to view
Figure 3: Fluorescein angiogram of the right eye revealing several micro-aneurysms and focal laser scars, but no crystals, which are isofluorescent

Click here to view



  Discussion Top


Triamcinolone has been shown to aggregate into crystalline structures that may resist the washout process and accumulate over the macula. [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. Whether the crystals retain any biological activity is unclear. 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.

 
  References Top

1.
Sarraf D, Vyas N, Jain A, Bui A, Kertes PJ, Freund KB, et al. Triamcinolone-associated crystalline maculopathy. Arch Ophthalmol 2010;128:685-90.  Back to cited text no. 1
[PUBMED]    
2.
Szurman P, Kaczmarek R, Jaissle GB, Grisanti S, Lüke M, Spitzer MS, et al. Influence of different purification techniques on triamcinolone yield and particle size spectrum. Graefes Arch Clin Exp Ophthalmol 2007;245:689-96.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]


This article has been cited by
1 Longstanding Crystalline Retinopathy Secondary to Intravitreal Triamcinolone Injection
Katherine Thomas, Jeffery Curry
Optometric Clinical Practice. 2022; 4(1): 5
[Pubmed] | [DOI]
2 LOCALIZATION OF MACULAR CRYSTALS ASSOCIATED WITH CHRONIC RETINAL DETACHMENT TO THE POSTERIOR HYALOID USING SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY
Elizabeth A. Atchison, Timothy P. Flood
RETINAL Cases & Brief Reports. 2021; 15(1): 81
[Pubmed] | [DOI]
3 Persistent Remnants of Dexamethasone Intravitreal Implant Over 24 Months in a Patient Suffering from Anterior and Intermediate Uveitis Associated with Macular Edema
Giorgio Enrico Bravetti, Jean Vaudaux, Jean-Antoine Pournaras, Aude Ambresin
Klinische Monatsblätter für Augenheilkunde. 2021; 238(04): 454
[Pubmed] | [DOI]
4 PERSISTENT REMNANTS OF DEXAMETHASONE INTRAVITREAL IMPLANT (OZURDEX)
Jee Taek Kim, Seok Hyun Lee, Sang Uk Choi
Retina. 2020; 40(11): 2226
[Pubmed] | [DOI]
5 Corticosteroids for the Treatment of Diabetic Macular Edema
Sumit Sharma,Prithvi Mruthyunjaya
Current Ophthalmology Reports. 2014;
[Pubmed] | [DOI]
6 Triamcinolone
Reactions Weekly. 2014; 1522(1): 158
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Case Report
Discussion
References
Article Figures

 Article Access Statistics
    Viewed3426    
    Printed77    
    Emailed0    
    PDF Downloaded167    
    Comments [Add]    
    Cited by others 6    

Recommend this journal