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Abstract
Purpose
To report retinal hemorrhage and retinal edema induced by the remaining triamcinolone acetonide (TA) used in vitrectomy for dyeing of vitreous and epiretinal membranes.
Case summary
The authors performed 23 gauze vitrectomies for macular epiretinal membranes. TA was used during the operation to enhance visualization of the vitreous and epiretinal membrane. At the end of the surgery, an amount of TA was left on the retinal surface. One day after the operation, the patient was maintained a semi-sitting position because of the floating TA particles in the vitreous cavity. The following day, the TA settled onto the inferior retina and retinal edema and hemorrhage occurred unexpectedly in the inferior retina. Vitrectomy was performed again and the fluid of the vitreous cavity was replaced with a fresh balanced salt solution and the settled TA was removed from retinal surface. Finally, argon laser photocoagulation was performed at the area where the retinal edema and hemorrhage had occurred. The retinal edema and hemorrhage disappeared after a few days, normal visual acuity was recovered in seven days, and a normal condition with no further ocular complications was maintained at six months.
Conclusions
When a TA vehicle, such as benzyl alcohol, and TA particles contained in the vehicle are left in the vitreous cavity and contact the retinal surface of a vitrectomized eye, retinal toxicity can be induced due to retinal edema and hemorrhage. The safest use of TA in vitrectomy would involve at least two rounds of sedimentation or filtration through a micofilter needle.
References
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Figure 1.
The pre-operative fundus photograph (A) and OCT images (B). Intra-operative findings shows epiretinal membrane peeling using triamcinolone acetonide for enhanced visualization of the epiretinal membrane (C, D). The features of fundus at the end of vitrectomy after epiretinal membrane removal (E).
Figure 2.
The fundus photographs taken two day after vitrectomy show clear vitreous cavity and posterior pole (A). But, triamcinolone acetonide settled down in the inferior retina and focal retinal edema and hemorrhage were noted under the flake of triamcinolone acetonide (B, C). Intra-operative fundus findings at the time of the second vitrectomy: Layered TA particle was removed with an extrusion needle (D) note retinal edema and hemorrhage in inferior retinal surface significantly (E), argon laser photocoagulation was done at the hemorrhagic and edematous retinal region (F).
Figure 3.
The fundus photographs taken one day after the second vitrectomy (A, B). The fundus photograph at 7day after the second operation (C). The FAG finding at 2 months after the second operation (D). The OCT images at 2 months after vitrectomy show reduction of macular thickness and absence of epiretinal membrane (E). The fundus photographs of 6 months after the second operation: the retina remains stable without any other complication (F).
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