PDF
ePub
Citation
Print
Abstract
Purpose
To report a case of macular infarction following intravitreal triamcinolone injection for treatment of central retinal vein occlusion.
Case summary
A 75-year-old male visited our clinic for visual disturbance in his left eye and was diagnosed with macular in-farction in his right eye. His medical history included type 2 diabetes, alcoholic liver cirrhosis, and hepatocellular carcinoma. After fundus examination, the patient was diagnosed with central vein occlusion with macular edema and intravitreal triamcinolone was administered to reduce edema. Within 1 week of treatment with the intravitreal injection, the patient experienced a sig-nificant decrease in visual acuity. Fluorescein angiogram showed an enlargement of the foveal avasacular zone, although opti-cal coherence tomography (OCT) showed a decreased macular edema. Despite normalization of macular thickness on OCT and cessation of leakage on angiography, visual acuity remained at the same level during 2 months of follow-up.
Go to : 
References
1. Haller JA, Bandello F, Belfort R Jr. . Dexamethasone intravitreal implant in patients with macular edema related to branch or central retinal vein occlusion twelve-month study results. Ophthal-mology. 2011; 118:2453–60.
2. Ip MS, Scott IU, VanVeldhuisen PC. . A randomized trial com-paring the efficacy and safety of intravitreal triamcinolone with ob-servation to treat vision loss associated with macular edema secon-dary to central retinal vein occlusion: the Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) study report 5. Arch Ophthalmol. 2009; 127:1101–14.
3. Brown DM, Campochiaro PA, Singh RP. . Ranibizumab for macular edema following central retinal vein occlusion: six-month primary end point results of a phase III study. Ophthalmology. 2010; 117:1124. 33.e1.
4. Boyer D, Heier J, Brown DM. . Vascular endothelial growth factor Trap-Eye for macular edema secondary to central retinal vein occlusion: six-month results of the phase 3 COPERNICUS study. Ophthalmology. 2012; 119:1024–32.
5. Leung LS, Silva RA, Blumenkranz MS. . Macular infarction following intravitreal bevacizumab for treatment of central retinal vein occlusion. Ophthalmic Surg Lasers Imaging. 2012; 43:Online: e73-9.
6. Jonas JB, Spandau UH, Schlichtenbrede F. Short-term complica-tions of intravitreal injections of triamcinolone and bevacizumab. Eye (Lond). 2008; 22:590–1.
7. Natural history and clinical management of central retinal vein occlusion The Central Vein Occlusion Study Group. Arch Ophthal-mol. 1997; 115:486–91.
8. Sim DA, Keane PA, Zarranz-Ventura J. . Predictive factors for the progression of diabetic macular ischemia. Am J Ophthalmol. 2013; 156:684–92.
9. Zachary I. Signaling mechanisms mediating vascular protective actions of vascular endothelial growth factor. Am J Physiol Cell Physiol. 2001; 280–C1375-86.
10. Nauck M, Karakiulakis G, Perruchoud AP. . Corticosteroids in-hibit the expression of the vascular endothelial growth factor gene in human vascular smooth muscle cells. Eur J Pharmacol. 1998; 341:309–15.
11. Nauck M, Roth M, Tamm M. . Induction of vascular endothe-lial growth factor by platelet-activating factor and platelet-derived growth factor is downregulated by corticosteroids. Am J Respir Cell Mol Biol. 1997; 16:398–406.
12. El Zaoui I, Behar-Cohen F, Torriglia A. Glucocorticoids exert di-rect toxicity on microvasculature: analysis of cell death mechan-isms. Toxicol Sci. 2015; 143:441–53.
13. Valamanesh F, Berdugo M, Sennlaub F. . Effects of triamcino-lone acetonide on vessels of the posterior segment of the eye. Mol Vis. 2009; 15:2634–48.
14. Conway BP, Tabatabay CA, Campochiaro PA. . Gentamicin toxicity in the primate retina. Arch Ophthalmol. 1989; 107:107–12.
15. Sim DA, Keane PA, Zarranz-Ventura J. . The effects of macular ischemia on visual acuity in diabetic retinopathy. Invest Ophthal-mol Vis Sci. 2013; 54:2353–60.
16. Onder C, Bengur T, Selcuk D. . Relationship between retinop-athy and cirrhosis. World J Gastroenterol. 2005; 11:2193–6.
17. Dittmer K, Nolte W, Tondrow M, Schwörer H. Pathologic fundus changes in advanced liver cirrhosis. Reduction of symptoms after portosystemic shunt. Ophthalmologe. 1998; 95:404–7.
Go to :
 | Figure 1.At initial visit, fundus photograph of left eye. (A) Dilated and tortuous retinal veins, flame-shaped retinal hem-orrhage and papilledema. (B, C) Optical coherence tomog-raphy demonstrates moderate macular edema. S = superior; N = nasal; T = temporal; I = inferior. |
 | Figure 2.Fluorescein angiography of right eye. (A, B) Early and late phase fluorescein angiography of right eye shows irregular en-largement of the foveal avascular zone temporally. |
 | Figure 3.A week after intravitreal injection of triamcinolone, the fundus photograph. (A) Diffuse whitening of the perimacular reti-na and attenuated retinal vasculature. (B) 8 weeks after intravitreal injection, persistent whitening of the posterior pole and newly developed disc hemorrhage was observed on fundus photograph. (C, D) However, optical coherence tomography shows decreased macular edema. S = superior; N = nasal; T = temporal; I = inferior. |
 | Figure 4.A week after intravitreal injection of triamcinolone, Fluorescein angiography. (A, B) A week after intravitreal injection of triamcinolone, the early phase of fluorescein angiography shows marked capillary non-perfusion of the macula. (C, D) The late phase of fluorescein andiography reveals persistent central macular nonperfusion with irregular margin. |
XML Download