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JAMA Ophthalmology Clinical Challenge
February 9, 2017

White Vitreous Deposits After Subtenon Steroid InjectionMore Than Meets the Eye

Author Affiliations
  • 1Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
JAMA Ophthalmol. Published online February 9, 2017. doi:10.1001/jamaophthalmol.2016.4192

A 58-year-old woman returned from the Ukraine with 3 months of constant blurry vision in the left eye. Her history was significant for glaucoma and breast cancer with brain metastasis treated with CyberKnife and whole-brain radiation. While abroad, she received 2 inferiorly placed periocular steroid injections and was treated with glaucoma drops for elevated pressures of 55 mm Hg. At presentation, her visual acuity was 20/20 OD and 20/50 OS, and intraocular pressures were 18 and 20 mm Hg, respectively. She had a left afferent pupillary defect and left superior visual field deficit. Slitlamp examination of the right eye was unremarkable, while the left eye showed 1+ cell in the anterior chamber and 1+ nuclear sclerosis with pigment on the anterior lens capsule. Posterior examination revealed 2+ whitish vitreous deposits, a cup-disc ratio of 0.8, and inferior retinal detachment with subretinal particulate material (Figure, A). B-scan showed vitreous, subhyaloid, and subretinal opacities without choroidal involvement (Figure, B). A magnetic resonance image of the brain and orbits did not reveal any new metastatic lesions.

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