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Triamcinolone injection may rarely fail to clear from the eye, but long-term effect is unknown
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VANCOUVER, British Columbia — Intravitreal injection of triamcinolone may rarely fail to clear from the retinal space, leaving depositions that have an unknown effect on retinal health.
"The concern is that perhaps with long-term persistence in the premacular bursa, as we've seen with cases, cell loss and cell death can take place through apoptosis and cell membrane lysis, which has been described in in vitro studies," David Sarraf, MD, said here at the American Society of Retina Specialists annual meeting.
Dr. Sarraf presented a series of 21 eyes of 13 patients with triamcinolone-associated crystalline maculopathy. In the series, patients received an average of two intravitreal triamcinolone injections (range: one to five) for recalcitrant cystoid macular edema. Patients were identified with the novel syndrome from 7 to 48 months after injection.
According to Dr. Sarraf, the syndrome is characterized by iridescent or refractile crystals that are white or yellow-green in appearance. Although variable, deposits were less than 63 µm in size. The crystals appeared in a central cluster or central ring pattern.
The syndrome is most likely due to large insoluble crystals that aggregate, clump and fall to the posterior hyaloid and bursa premacularis after failing to wash out of the eye, Dr. Sarraf said.