Triamcinolone
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Triamcinolone Cyst following subtenon administration: case report A 29-year-old man developed a subtenon cyst following a subtenon injection of triamcinolone for chronic recurrent uveitis. The man, who had a history of Behcet’s syndrome and had received a fluocinolone acetonide implant in his left eye, received subtenon triamcinolone 60mg (40 mg/mL; Kenacort A] in his right eye. After 11 months, he developed bilateral recurrent panuveitis with retinitis and vitiritis. He recieved bilateral subtenon injections of triamcinolone 40mg; during the left-eye injection, resistance was felt when the needle was advanced into the subtenon space, resulting in inadvertent anterior and superficial triamcinolone deposition; this led to the formation of a subconjunctival bulging mass in his superonasal quadrant [time to reaction onset not clearly stated]. After 2 months, panuveitis persisted in his left eye and he required a second subtenon injection after which the panuveitis in his left eye started to regress; although it decreased minimally in size, the anterior subtenon cyst persisted. Four and a half months after his initial subtenon injection, he developed refractory corticosteroid-induced glaucoma. The man underwent a trabeculectomy and his subtenon cyst was excised to assist the filtration surgery. Gross examination revealed a mass that was opaque white, cystic and firm with a vascularised surface, measuring 6 × 5 × 1mm. Histological examination of frozen sections of the mass revealed birefringent deposits consistent with triamcinolone crystals. His recovery was uneventful and, 18 months after his trabeculectomy, his left eye intraocular pressure was controlled without medication and the uveitis in both eyes remained regressed. Author comment: "A combination of factors such as the presence of triamcinolone crystals inducing an inflammation in the superficial anterior subtenon space that is conducive to inflammation in this patient with Beh¸cet’s disease, may have led to the formation of the cyst in our patient." Chan CKM, et al. Encapsulated triamcinolone cyst after subtenon injection. Clinical and Experimental Ophthalmology 34: 360-362, No. 4, May-Jun 2006 801043711 China
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Reactions 9 Sep 2006 No. 1118
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