Retinal pigment epithelial tear after intravitreous triamcinolone acetonide injection for fibrovascular pigment epithelial detachment.

Abstract

A 78-year-old woman was diagnosed with fibrovascular pigment epithelial detachment (PED) associated with age-related macular degeneration (AMD) affecting both eyes. Due to decreased vision in her left eye (20/2000) and disease progression, the patient received 4 mg of triamcinolone acetonide (TA) by intravitreal injection into her left eye. There were no immediate post-injection complications in the left eye. However, one week later, a retinal pigment epithelial (RPE) tear, temporal-inferior to the fovea in the left eye, was noted and confirmed by fundus photography, fluorescein angiography and optical coherence tomography. In contrast, there no similar RPE tear occurred in her right eye after treated several times by intravitreous bevacizumab injection. Not only anti-vascular endothelium growth factor agents, but also intravitreal TA when used to treat AMD with PED, would seem to induce a RPE tear in the absence of previous or concurrent adjuvant therapy. Further investigations are required to confirm the mechanism by which the RPE tear occurs.