Retinal Hemorrhage Induced by Triamcinolone Acetonide Left After Vitrectomy for Macular Epiretinal Membrane

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.