OBJECTIVE: 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-green, asymmetric in distribution, and deposited as a cluster in the central macula or in a perifoveal distribution. The crystals were benign and unassociated with visual deficit. Preretinal hyperreflective deposits were noted with optical coherence tomography. Two eyes underwent vitrectomy with membrane peeling, and the crystals were no longer present postoperatively. CONCLUSIONS: We describe a novel syndrome of crystalline maculopathy associated with a history of intravitreous triamcinolone injections. The crystals are refractile, multicolored, located in the posterior pole, and unassociated with obvious visual deficit or retinal sequelae. The predominantly white color and superficial location of the crystals indicate that they may result from aggregation and clumping of insoluble components of triamcinolone.
OBJECTIVE: 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-green, asymmetric in distribution, and deposited as a cluster in the central macula or in a perifoveal distribution. The crystals were benign and unassociated with visual deficit. Preretinal hyperreflective deposits were noted with optical coherence tomography. Two eyes underwent vitrectomy with membrane peeling, and the crystals were no longer present postoperatively. CONCLUSIONS: We describe a novel syndrome of crystalline maculopathy associated with a history of intravitreous triamcinolone injections. The crystals are refractile, multicolored, located in the posterior pole, and unassociated with obvious visual deficit or retinal sequelae. The predominantly white color and superficial location of the crystals indicate that they may result from aggregation and clumping of insoluble components of triamcinolone.
Authors: Claudine E Pang; Jeffrey D Messinger; Emma C Zanzottera; K Bailey Freund; Christine A Curcio Journal: Ophthalmology Date: 2015-08-19 Impact factor: 12.079