Supplementary Material for: A Case of Incidental and Uncomplicated Subretinal Triamcinolone Acetonide

Introduction:
Posterior subtenon injection of triamcinolone acetonide (PSTA) is commonly done to treat refractory cases of macular edema. Complications may arise from the procedure as well as from the use of the periocular steroid medications. Side effects include subconjunctival hemorrhage, progression of cataract, scleral perforation (resulting in subretinal, subhyaloid, or intravitreal injection of the drug), retinal detachment, ptosis, orbital fat prolapse, orbital abscess, infectious scleritis, ocular hypertension, and scleral abscess. Here we describe a case of inadvertent sub-retinal triamcinolone acetonide (TA) deposition from a PSTA procedure without any adverse vision-threatening outcomes.

Case Presentation:
We report a patient who presented with a history of superior temporal left eye macula-off rhegmatogenous retinal detachment, which was successfully repaired with a scleral buckle (SB), pars plana vitrectomy, and gas placement. Due to persistent diplopia, the scleral buckle was removed after 1 year post-operatively. Due to the development of cystoid macular edema, a PSTA was performed after the patient failed topical steroids and NSAIDs. The procedure was halted early due to unexpected resistance during the injection. A dilated fundus exam showed the presence of subretinal triamcinolone acetonide. The patient was observed and found to have no complications with almost complete resolution of the triamcinolone acetonide after 3 months.

Conclusion:
In previous scleral buckle patients, it is important to highlight the risk of globe penetration, subretinal deposition of TA, formation of retinal breaks, or re-opening of prior retinal breaks with posterior sub-tenon injection, which could have adverse effects on the local retina as well as the risk of retinal detachment.

引言：曲安奈德后Tenon囊下注射（Posterior subtenon injection of triamcinolone acetonide, PSTA）是治疗难治性黄斑水肿的常用手段。该操作及眼周类固醇药物的使用均可能引发并发症，不良反应包括结膜下出血、白内障进展、巩膜穿孔（可导致药物注入视网膜下、玻璃体下或玻璃体内）、视网膜脱离、上睑下垂、眶脂肪脱垂、眶脓肿、感染性巩膜炎、高眼压症及巩膜脓肿。本文报告1例因PSTA操作导致意外视网膜下曲安奈德（triamcinolone acetonide, TA）沉积，但未出现任何威胁视力的不良结局的病例。

病例报告：本例报告1例患者，其有左眼颞上方黄斑脱离型孔源性视网膜脱离病史，接受巩膜扣带术（scleral buckle, SB）、经睫状体平坦部玻璃体切除术及玻璃体腔气体填充术后成功复位。因持续复视，术后1年移除了巩膜扣带。患者因出现囊样黄斑水肿，在局部类固醇及非甾体抗炎药（non-steroidal anti-inflammatory drugs, NSAIDs）治疗无效后，接受了PSTA治疗。注射过程中遭遇意外阻力，遂提前终止操作。散瞳眼底检查显示存在视网膜下曲安奈德沉积。对患者进行随访观察，3个月后曲安奈德几乎完全吸收，且未出现任何并发症。

结论：对于既往接受过巩膜扣带术的患者，需重点强调PSTA操作存在眼球穿孔、TA视网膜下沉积、新发视网膜裂孔或既往视网膜裂孔再次开放的风险，此类风险可对局部视网膜造成不良影响，且存在视网膜脱离的可能。