OSLI Retina

July 2019

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466 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ I M A G E S I N O P H T H A L M O L O G Y ■ Accidental Globe Perforation during Posterior Sub-Tenon's Injection of Triamcinolone Acetonide Simar Rajan Singh, MS; Mohit Dogra, MS; Ramandeep Singh, MS; Mangat Ram Dogra, MS ABSTRACT: Complications of posterior sub-Tenon's steroid injections like glaucoma, cataract, sub-con- junctival hemorrhage and ptosis are well known. The authors present this photo essay to highlight a rare but serious complication of globe perforation secondary to posterior sub-Tenon's triamcinolone injection and describe its management. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:466-467.] A 58-year-old diabetic male presented with com- plaints of sudden painful vision loss in his right eye (OD) following a posterior sub-Tenon's (PST) injection of triamcinolone acetonide (TA) for diabetic macular edema (DME) elsewhere. He had a visual acuity (VA) of counting fingers close to face. Slit-lamp examination (Figure 1A) revealed a scleral rupture and exposure of the ciliary body (red arrow) in the upper temporal quadrant with a deposit of TA seen posteriorly (yellow arrow). Intraocular pressure was 10 mm Hg on non-con- tact tonometry. Fundus examination revealed intravit- real and subretinal deposit of TA with accompanying subretinal and vitreous hemorrhage (Figure 1B). A di- agnosis of inadvertent globe perforation with subretinal TA during PST injection was made. OD was subjected to 25-gauge pars plana vitrectomy with displacement of subretinal steroid and blood with silicone oil and face- down positioning. At 6 months' follow-up, the patient's VA improved to 20/120 with an attached retina and presence of residual subretinal TA superior to the fovea (Figure 1C). PST TA is generally given to patients with DME and posterior uveitis. 1 If given incorrectly, there is a risk of accidental ocular perforation leading to retinal tears, subretinal hemorrhage, vitreous hemorrhage, retinal detachment, and subretinal/vitreous deposi- tion of TA. 2 There are various methods described for PST injection. Cannula method should be the pre- ferred as it is as efficacious as the Smith and Nozik From Advanced Eye Centre, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. Originally submitted November 25, 2018. Revision received November 25, 2018. Accepted for publication February 1, 2019. The authors report no relevant financial disclosures. The authors would like to acknowledge the technical staff of the Retina Lab at Advanced Eye Centre, PGIMER, Chandigarh – Arun Kapil, Sushil Bhatt and Nitin Gautam – for the help with acquiring the photographs of the patient. Address correspondence to Mohit Dogra, MS, Advanced Eye Center, Dept. of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India; email: drmohitdogra@gmail.com. doi: 10.3928/23258160-20190703-11

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