Persistent unsealed sclerotomy after intravitreal injection of triamcinolone acetonide with a 30-gauge needle

We report the case of a persistent unsealed sclerotomy following intravitreous injection of triamcinolone through the pars plana using a 30-gauge needle. The injection was made for the treatment of diabetic macular edema. The eye had been treated 9 months before by pars plana vitrectomy and pan retinal photocoagulation for vitreous hemorrhage complicating diabetic proliferative retinopathy. Five days after injection, the patient presented with severe hypotony and chemosis. A conjunctival Seidel was noted at the site of injection. Surgical exploration revealed a punctiform scleral wound without vitreous incarceration, which was closed with a 10-0 nylon suture. No other complication occurred. Our observation highlights that in spite of its simplicity, intravitreous injection of triamcinolone is an invasive procedure that requires rigorous follow-up. In vitrectomized eyes, the higher risk of unsealed scleral wound after intravitreous injection should encourage this injection to be made in a site where no sclerotomy usually occurs. The 6'o-clock meridian could be a good location.