Triamcinolone
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Increased intraocular pressure and cataract: 2 case reports A 62-year-woman and a 65-year-old man developed increased intraocular pressure and cataract following administration of triamcinolone for macular oedema. Case 1: A 62-year-old woman was diagnosed with macular oedema due to retinal vein occlusion in the right eye. After receiving proxymetacaine [alcaine] eye drops as surface anaesthesia, she received intravitreal triamcinolone [triamcinolone acetonide] 0.1 mL/4mg. On the first day after the injection, a slit-lamp examination revealed a villiform opacity of triamcinolone particles behind the posterior capsule, with a visible capsular perforation on the posterior side of the lens. She reported blurry vision without other discomfort. Her best-corrected visual acuity (BCVA) was limited to fingers in front of the eyes. Her intraocular pressure (IOP) was 19mm Hg. Two weeks post-injection, an examination showed that the suspended triamcinolone particles had a tendency to be absorbed; her BCVA improved to 20/166 and the IOP was 20 mmHg. One month post-injection, further absorption of suspended triamcinolone was observed. Examinations showed BCVA and IOP were 20/133 and 21 mmHg, respectively. Fuzzy fundus was also observed. Eight months after the injection, retro-illumination revealed maximum absorption of triamcinolone particles, limited rice crust opacity along with posterior sub-capsular opacification. Cataract was suspected. Her BCVA improved to 20/100. However, IOP increased to 32 mmHg without inflammation. Hence timolol, brimonidine and latanoprost were prescribed. Her IOP eventually normalised. Nine months after the injection, she underwent cataract surgery. During surgery, posterior capsule holes were noted. Iatrogenic crystalline lens injury due to needle puncture during intravitreal triamcinolone administration, and an increased IOP and subsequent cataract development due to triamcinolone was suspected. She was found to be normal without complications during further follow-up visits. Case 2: A 65-year-old man was diagnosed with macular oedema due to retinal vein occlusion in the right eye. After receiving proxymetacaine [alcaine] eye drops as surface anaesthesia, he received intravitreal triamcinolone [triamcinolone acetonide] 0.1 mL/4mg. On the first day after the injection, examinations showed BCVA 20/200, intraocular pressure (IOP) 42 mmHg and lens opacity along with expansion. Cataract was suspected. Owing to the increased IOP, he was treated with unspecified anti-glaucoma medications. However, his IOP could not be controlled. One week after the triamcinolone injection, he underwent cataract surgery. Four weeks after the surgery, IOP was 16 mmHg and BCVA was 20/50. Iatrogenic crystalline lens injury due to needle puncture during intravitreal triamcinolone administration, and an increased IOP and subsequent cataract development due to triamcinolone was suspected. At further follow-up visits, he appeared normal, without any complications. Su J, et al. Iatrogenic crystalline lens injury during intrav
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