Modified inexpensive needle for suprachoroidal triamcinolone acetonide injections in pseudophakic cystoid macular edema

Abstract

Pseudophakic cystoid macular edema (PCME) is one of the leading causes of reduced vision, after cataract surgery. Topical steroids and nonsteroidal anti-inflammatory drops are frequently used in the management; however, intravitreal injections may be required for chronic cases. Suprachoroidal injection of preservative free Triamcinolone acetonide is a recent addition to the therapeutic armamentarium of ophthalmologists for treatment of cystoid macular edema of varied etiology. Though the drug is commercially available at a reasonable cost, the microneedle is not commonly available. We modified a 26 G needle for safe and cost-effective delivery of preservative-free suprachoroidal triamcinolone acetonide (SCT). In the current series of three patients with non-resolving PCME, macular edema resolved and vision improved over 3 months.

Keywords: Cataract surgery complications; pseudophakic macular edema; suprachoroidal injection; suprachoroidal steroids; triamcinolone.

Figure 1

(a) The outer sheath of intracath is cut and used to cover the 26-gauge needle till the bevelled edge. (b) The outer sheath of intracath expose 1 mm bevelled end of the needle reconfirmed by measuring with calipers. (c) Intraoperative photograph showing the needle in suprachoroidal space at 4 mm from the limbus. (d) Baseline optical coherence tomography with prominent cystic spaces and macular edema. (e) Slit-lamp photograph showing injection site with minimal congestion. (f) Optical coherence tomography with reduction in intraretinal cysts and resolving macular edema