Accidental subretinal injection of triamcinolone acetonide

Approximately one-third of the contents of a 1-ml, 40-mg ampule of triamcinolone acetonide was accidentally injected into the subretinal space of the left eye of a 30-year-old man with chronic uveitis. The manufacturer provided a list of the contents of the ampule. A large, white subretinal mass was seen in the superotemporal quadrant. In subsequent days, the medication was seen to migrate inferiorly. Visual acuity in the left eye was 20/400. Subretinal hemorrhage and mild atrophy of the retinal pigment epithelium and choroid were observed superotemporally. Visual acuity returned to 20/100 (preinjection level) in 1 week. Four months postinjection, the superotemporal atrophy was more severe; the inferotemporal medication was minimally visible without producing significant chorioretinal atrophy. The visual acuity remained at 20/100 until the patient underwent cataract extraction and intraocular lens implantation; his vision then improved to 20/40. Steroids, when not accompanied by harmful vehicle substances, may be well tolerated by ocular tissues.