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Jeon, Park, Lee, Lee, and Oum: Histopathologic Features of Triamcinolone Deposits in Refractory Steroid-Induced Glaucoma after Subtenon Triamcinolone Injection
Case Report
Journal of the Korean Ophthalmological Society

Journal of the Korean Ophthalmological Society 2012; 53(5): 733-739.

Published online: 16 May 2012

DOI: https://doi.org/10.3341/jkos.2012.53.5.733

Histopathologic Features of Triamcinolone Deposits in Refractory Steroid-Induced Glaucoma after Subtenon Triamcinolone Injection

Hye Shin Jeon, MD1, Won Young Park, MD2, Ji Woong Lee, MD, PhD1, Ji Eun Lee, MD, PhD1, Boo Sup Oum, MD, PhD1

1Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea.

2Department of Pathology, Pusan National University School of Medicine, Busan, Korea.

Address reprint requests to Ji Woong Lee, MD, PhD. Department of Ophthalmology, Pusan National University Hospital, #179 Gudeok-ro, Seo-gu, Busan 602-739, Korea. Tel: 82-51-240-7326, Fax: 82-51-242-7341, alertlee@hanmail.net

Received 11 May 2011       Accepted 2 April 2012

Copyright © 2012 The Korean Ophthalmological Society

Abstract

Purpose

To report the removal of subtenon triamcinolone precipitates in patients with refractory steroid-induced glaucoma following subtenon triamcinolone injection.

Case summary

A 72-year-old male patient with diabetic retinopathy had cystoid macular edema in the right eye. The patient received a posterior subtenon injection of triamcinolone acetonide and developed intractable glaucoma one month after the injection in the right eye. Corticosteroid-deposit was excised three month after the injection. The intraocular pressure decreased to normal within one month after surgery and remained normal for seven months after surgery. A 42-year-old man with bilateral chronic recurrent anterior uveitis received a posterior subtenon triamcinolone acetonide injection in both eyes. The patient developed refractory steroid-induced glaucoma one month after the injection in the right eye. Corticosteroid-deposit was excised six months after the injection in the right eye. The patient's intraocular pressure decreased to normal within two weeks after surgery and remained normal. Light microscopy showed a fibrous capsule encapsulating an amorphous whitish material. The excised specimen with polarized light showed birefringence of triamcinolone crystals within an encapsulated cyst.

Conclusions

Removal of subtenon triamcinolone acetonide precipitate may facilitate the management of patients developing increased intraocular pressure unresponsive to maximum tolerable medical therapy and should be considered before performing glaucoma filtration surgery.

Keywords: Glaucoma, Subtenon, Triamcinolone

Figures and Tables

Figure 1
Case 1. (A) Intraoperative photograph showing a white mass (black arrow) in the inferonasal quadrant of the right eye. (B) The white mass (black arrow) is surgically removed. (C) Histological section in haematoxylin and eosin stain showing a well-encapsulated mass surrounded by fibrous tissue and large foci of amorphous granular stromal degeneration (×200). (D) Formalin-fixed frozen section with polarized light shows birefringence of triamcinolone crystals (white arrow) within an encapsulated cyst (×200).
jkos-53-733-g001
Figure 2
Case 2. (A) Intraoperative photograph showing a white mass (black arrow) in the inferonasal quadrant of the right eye. (B) The white mass (black arrow) is surgically removed. (C) Histological section in haematoxylin and eosin stain showing amorphous granular stromal degeneration with polymorphonuclear neutrophil and macrophage (×200).
jkos-53-733-g002

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