G B Jaissle1, K U Bartz-Schmidt, P Szurman. 1. Universitäts-Augenklinik, Schleichstrasse 12, 72076, Tübingen, Deutschland. g.jaissle@med.uni-tuebingen.de
Abstract
BACKGROUND: Although current in vitro studies show local cytotoxicity of triamcinolone (TA) crystals if they are in direct contact with cells, a toxic effect of epiretinal TA deposits has not been reported yet clinically. For the first time, we present a case of potential cytotoxicity of epiretinal TA deposits in vivo. CASE REPORT: A 68-year old patient underwent a re-vitrectomy with peeling of a macular pucker and the internal limiting membrane (ILM) combined with an intravitreal injection of 25 mg TA due to a secondary macular pucker with cystoid macular edema. Postoperatively, pronounced epiretinal deposits of TA crystals were identified in the area of the posterior pole. Two months after the injection a consecutive optic atrophy with central visual field defect and severe reduction of the visual acuity to hand movements was apparent. CONCLUSION: Our case report indicates possible in-vivo toxicity of TA deposits in eyes subsequent to vitrectomy and peeling of the ILM. This is in accordance with previous in-vitro studies showing ILM and vitreous to be protective biological factors, but demonstrate pronounced cytotoxicity if TA crystals are allowed to directly adhering to denuded ganglion cells. Hence, we consider that TA injection should be carefully weighed in those patients with prior ILM removal.
BACKGROUND: Although current in vitro studies show local cytotoxicity of triamcinolone (TA) crystals if they are in direct contact with cells, a toxic effect of epiretinal TA deposits has not been reported yet clinically. For the first time, we present a case of potential cytotoxicity of epiretinal TA deposits in vivo. CASE REPORT: A 68-year old patient underwent a re-vitrectomy with peeling of a macular pucker and the internal limiting membrane (ILM) combined with an intravitreal injection of 25 mg TA due to a secondary macular pucker with cystoid macular edema. Postoperatively, pronounced epiretinal deposits of TA crystals were identified in the area of the posterior pole. Two months after the injection a consecutive optic atrophy with central visual field defect and severe reduction of the visual acuity to hand movements was apparent. CONCLUSION: Our case report indicates possible in-vivo toxicity of TA deposits in eyes subsequent to vitrectomy and peeling of the ILM. This is in accordance with previous in-vitro studies showing ILM and vitreous to be protective biological factors, but demonstrate pronounced cytotoxicity if TA crystals are allowed to directly adhering to denuded ganglion cells. Hence, we consider that TA injection should be carefully weighed in those patients with prior ILM removal.
Authors: Peter Szurman; Radoslaw Kaczmarek; Martin S Spitzer; Gesine B Jaissle; Patrice Decker; Salvatore Grisanti; Sigrid Henke-Fahle; Sabine Aisenbrey; Karl U Bartz-Schmidt Journal: Exp Eye Res Date: 2006-05-08 Impact factor: 3.467
Authors: Peter Szurman; Ana Sierra; Radoslaw Kaczmarek; Gesine B Jaissle; Barbara Wallenfels-Thilo; Salvatore Grisanti; Matthias Lüke; Karl U Bartz-Schmidt; Martin S Spitzer Journal: Exp Eye Res Date: 2007-03-19 Impact factor: 3.467
Authors: Chi Kong Yeung; Kwok Ping Chan; Sylvia W Y Chiang; Chi Pui Pang; Dennis S C Lam Journal: Invest Ophthalmol Vis Sci Date: 2003-12 Impact factor: 4.799