Triamcinolone
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Triamcinolone Ophthalmic and central retinal artery occlusion following inadvertent lacrimal artery catheterisation: case report
A72-year-old woman developed ophthalmic and central retinal artery occlusion following inadvertent lacrimal artery catheterization during triamcinolone administration for repeated left orbital decompression during surgery. The woman had a history of controlled hypertension, thyroid eye disease and bilateral orbital decompression surgery. She underwent repeated left orbital decompression with lacrimal gland triamcinolone injection [dosage not stated]. The day after surgery, a vision loss was noted on patch removal. Examination on postoperative day 1 showed positive left afferent pupillary defect, corneal oedema and visual acuity of counting fingers OS. At postoperative day 6, despite improved corneal oedema, her visual acuity worsened to light perception OS. Posterior segment examination did exhibit retinal whitening, a cherry-red spot, and multiple intra-arterial yellowish plaques. But, it did not reveal optic disc pallor or oedema. Optical coherence tomography showed hyperreflectivity and thickening of the inner and middle retinal layers corresponding to the areas of retinal whitening on examination. Fluorescein angiography revealed abrupt cessation of arterial blood flow at the embolic plaques seen on examination, marked macular hypo-fluorescence, and nasal hypo-fluorescence and hyper-fluorescence. The etiology was presumed to be iatrogenic triamcinolone embolus and she underwent immediate stroke workup. At postoperative month 1, visual acuity continued to remain at light perception OS. It was proposed that the lacrimal artery was inadvertently catheterised during the injection, which resulted in retrograde flow into the ophthalmic artery. Several factors were suggestive of ophthalmic artery occlusion in addition to retinal artery occlusion. These factors include, the presence of corneal oedema, dramatic deterioration of visual acuity and the presence of superonasal retinal pigmented epithelium abnormalities on fluorescein angiography suggesting choroidal ischaemia. Raufi NN, et al. Ophthalmic and Central Retinal Artery Occlusion Following Triamcinolone Injection of the Lacrimal Gland. JAMA Ophthalmology 137: 1460-1461, No. 12, 803448246 Dec 2019. Available from: URL: http://doi.org/10.1001/jamaophthalmol.2019.3998
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Reactions 25 Jan 2020 No. 1788
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