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OPHTHALMIC IMAGE
Year : 2022  |  Volume : 2  |  Issue : 1  |  Page : 331

Intraoperative sub-internal limiting membrane migration of triamcinolone particles


Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India

Date of Web Publication07-Jan-2022

Correspondence Address:
Dr. Piyush Kohli
Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1427_21

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How to cite this article:
Babu N, Kohli P, Ramasamy K. Intraoperative sub-internal limiting membrane migration of triamcinolone particles. Indian J Ophthalmol Case Rep 2022;2:331

How to cite this URL:
Babu N, Kohli P, Ramasamy K. Intraoperative sub-internal limiting membrane migration of triamcinolone particles. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Jan 16];2:331. Available from: https://www.ijoreports.in/text.asp?2022/2/1/331/334877



A 50-year-old female with no systemic comorbidities presented with nonresolving vitreous hemorrhage (VH) after a “yoga” session. During vitrectomy, intravitreal triamcinolone was used to ensure posterior hyaloid removal. However, some triamcinolone particles settled inside a premacular cavity under the internal limiting membrane (ILM) [[Figure 1] and Video 1] [Additional file 1].
Figure 1: Intraoperative images using NGENUITY® 3D Visualization System (Alcon, Forth Worth, Texas, USA) showing (a) triamcinolone particles settled in a premacular cavity under Brilliant Blue G-stained internal limiting membrane (ILM), and margins of the sub-ILM cavity/arcus retinalis (black arrow); (b) opening of the premacular cavity during ILM peeling; (c) remnant triamcinolone particles after ILM was completely peeled; and (d) triamcinolone particles removed from the persistent premacular cavity

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She was diagnosed to have a breakthrough VH secondary to Valsalva retinopathy. Triamcinolone can enter the persistent premacular cavity after a forceful intravitreal injection, through a preexisting ILM defect. The ILM defect and the premacular cavity form after spontaneous or laser-induced release of sub-ILM hemorrhage.[1],[2],[3],[4] “Arcus retinalis” has been described as a clinical marker for sub-ILM cavity.[5]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Meyer CH, Mennel S, Rodrigues EB, Schmidt JC. Persistent premacular cavity after membranotomy in valsalva retinopathy evident by optical coherence tomography. Retina 2006;26:116-8.  Back to cited text no. 1
    
2.
Pérez-Rico C, Montes-Mollón Á, Castro-Rebollo M, Pareja-Esteban J, Benítez-Herreros J. Optical coherence tomography features of sub-internal limiting membrane hemorrhage and temporary premacular cavity following Nd-YAG laser membranotomy in Valsalva retinopathy. Jpn J Ophthalmol 2008;52:513-5.  Back to cited text no. 2
    
3.
Tripathy K, Chawla R, Vekaria L, Sharma YR. Sub-internal limiting membrane cavity following Valsalva retinopathy resembling central serous chorioretinopathy. J Ophthalmic Vis Res 2018;13:83-4.  Back to cited text no. 3
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4.
Goel N, Kumar V, Seth A, Raina UK, Ghosh B. Spectral-domain optical coherence tomography following Nd: YAG laser membranotomy in Valsalva retinopathy. Ophthalmic Surg Lasers Imaging 2011;42:222-8.  Back to cited text no. 4
    
5.
Kumar V, Goel N. “Arcus retinalis”: A novel clinical marker of sub-internal limiting membrane hemorrhage. Eur J Ophthalmol 2020;1120672120934958. doi: 10.1177/1120672120934958. Online ahead of print.  Back to cited text no. 5
    


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