This 73YOF was referred for persistent bilateral symptomatic pseudophakic cystoid macular edema (CME) despite a course of topical therapy. Vision was 20/70 OU.
During the triamcinolone subtenon injection, given through the inferior conjunctival cul-de-sac, the patient complained of severe pain, and the red reflex turned white. We immediately removed the needle. Triamcinolone was dispersed throughout the vitreous cavity; no retinal detachment or break could be identified, and the intraocular pressure was remarkably normal.
When examined two days later, vision was hand motion due to residual triamcinolone, and the retina remained attached. One week later, the examination was unchanged, and she requested that the material be removed. At vitrectomy, the penetration was noted in the inferior midperiphery without open breaks or detachment. Three weeks following vitrectomy, vision was 20/40, with faint residual blood and chorioretinal scarring.
Not knowing how to proceed immediately after the initial injection, the patient allowed us to perform a subtenon injection in the left eye, which was thankfully completely uneventful. Vision returned to 20/40 within a few weeks with resolved CME.
