A 55-year-old female with bilateral intermediate uveitis presented with decreased vision in the right eye. She had received multiple posterior subtenon triamcinolone (PST) injections with good response; the best-corrected visual acuity (BCVA) 2 months earlier was logMAR 0.3. At presentation, BCVA was finger counting at 0.5 m, the intraocular pressure (IOP) was 15 mmHg, and slit-lamp showed 1 + anterior chamber cells. The patient was pseudophakic, and fundus view was limited by vitritis. A PST injection of 20 mg triamcinolone acetonide was administered superotemporally using a 27-gauge needle (Nozik technique). The patient reported sudden pain. Fundus examination revealed subretinal triamcinolone in the superotemporal quadrant, extending to the arcades but sparing the macula, with additional intravitreal deposits Fig. 1. There was no retinal detachment. BCVA remained finger counting; IOP was 20 mmHg. Conservative management was adopted. Two days later, the perforation site was visible and lasered. Over 1 month, the drug gradually resorbed leaving minimal residual subretinal drug, and BCVA improved to logMAR 0.5 Fig. 2. Posterior subtenon triamcinolone injections are widely used for intermediate and posterior uveitis, but globe perforation—though rare—remains a vision-threatening complication. In this case, macular sparing permitted conservative management, and laser at the perforation site likely prevented retinal detachment. This case highlights the need for a meticulous technique, particularly in eyes with risk factors such as high myopia, scleral thinning, or repeated injections.Figure 1: Fundus photograph showing hazy media due to vitritis. A large area of subretinal triamcinolone deposition is seen in the superotemporal quadrant (black star), extending toward the vascular arcades but sparing the fovea. Intravitreal triamcinolone particles are also visible (white arrowhead)Figure 2: One-month follow-up fundus photograph of the same eye. Most of the subretinal triamcinolone has resorbed, leaving behind only a small residual deposit in the superotemporal quadrant (black arrow). Laser scars at the site of scleral perforation are seen (white arrowhead), placed using laser indirect ophthalmoscopy to prevent subsequent detachmentAuthors contributions Adithi K Murthy: Definition of intellectual content, manuscript preparation, manuscript editing, manuscript review; Shakha: Concept and design, literature search, manuscript review; Muskan Garg: Data acquisition, manuscript editing and review. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.
Murthy et al. (Thu,) studied this question.