J Korean Ophthalmol Soc.  2015 Nov;56(11):1804-1809. 10.3341/jkos.2015.56.11.1804.

Macular Infarction Following Intravitreal Triamcinolone Injection for Treatment of Central Retinal Vein Occlusion

• Lee JH
• Kim TK
• Lee YC
• Lee MY

• KMID: 2214192
• DOI: http://doi.org/10.3341/jkos.2015.56.11.1804

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 infarction 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 significant decrease in visual acuity. Fluorescein angiogram showed an enlargement of the foveal avasacular zone, although optical 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.
CONCLUSIONS
Intravitreal anti-vascular endothelial growth factor injection as well as intravitreal triamcinolone injection can cause macular ischemia which should be considered with the adopted treatment regimen for patients with ischemic risk factors.

Keyword

Central retinal vein occlusion; Ischemic maculopathy; Triamcinolone acetonide

MeSH Terms

Aged
Angiography
Carcinoma, Hepatocellular
Edema
Endothelial Growth Factors
Fluorescein
Follow-Up Studies
Humans
Infarction*
Intravitreal Injections
Ischemia
Liver Cirrhosis, Alcoholic
Macular Edema
Male
Retinal Vein*
Risk Factors
Tomography, Optical Coherence
Triamcinolone Acetonide
Triamcinolone*
Veins
Visual Acuity
Endothelial Growth Factors
Fluorescein
Triamcinolone
Triamcinolone Acetonide

Figure

• 

  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.

Reference

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