J Korean Ophthalmol Soc.  2012 May;53(5):733-739.

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

• Jeon HS
• Park WY
• Lee JW
• Lee JE
• Oum BS

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.

Keyword

Glaucoma; Subtenon; Triamcinolone

MeSH Terms

Adult
Aged
Birefringence
Diabetic Retinopathy
Eye
Filtering Surgery
Glaucoma
Humans
Intraocular Pressure
Light
Macular Edema
Male
Microscopy
Triamcinolone
Triamcinolone Acetonide
Uveitis, Anterior
Triamcinolone
Triamcinolone Acetonide

Figure

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  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).

• 

  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).

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