Suprachoroidal Triamcinolone Acetonide For Postoperative Vitritis Following Phacoemulsification: A Case Report

To describe clinical outcome of a patient presented with vitritis post phacoemulsification treated with Suprachoroidal steroid (SCS), not responding to topical and systemic steroids.

District Headquarter Hospital, Sheikhupura, Pakistan.

A male patient , 65 yr old, diabetic & hypertensive, with the history of TIA ( Transient Ischemic Attack) one year ago, underwent uneventful phacoemulsification + PC-IOL. 3 days post phaco, he complained of decreased vision and red eye. On Examination, visual acuity was finger counting in left eye not improving with refraction. On slit lamp examination, mild AC flare + hazy view of retina due to cells in vitreous, B-scan showed echoes in vitreous confirming vitritis and attached retina.

Intensive topical steroid with antibiotics were given but no visual improvement seen. Suprachoroidal injection triamcinolone acetonide 4mg/0.1ml given under aseptic condition with custom made 24 guage needle to ensure precise penetration in Suprachoroidal space.

There was no IOP rise on first post-op day. After 2 weeks vision improved to 6/18, no vitreous activity with clear fundus.

This case highlights the presentation of vitritis in a patient 3 days post uneventful surgery. Most reported cases describe post surgical cystoid macular edema, whereas in this case we dealt with post surgical vitritis not responding to topical & systemic medications. This case emphasizes the importance of considering suprachoroidal triamcinolone acetonide in patients who aren’t responding to topical medications. This technique also reduces risk of post injection raised IOP & cataract formation. Visual outcome post injection is also rewarding.

SCS is efficacious & safer to use with low incidence of raised IOP post-injection.