Acute macular neuroretinopathy in a patient with birdshot chorioretinopathy after intravitreal triamcinolone suspension injection

Eur J Ophthalmol. 2023 Sep;33(5):NP35-NP40. doi: 10.1177/11206721221124653. Epub 2022 Sep 4.


Purpose: To report a case of acute macular neuroretinopathy (AMN) after intravitreal triamcinolone acetonide (TRIESENCE®) injection for cystoid macular edema secondary to birdshot chorioretinopathy.

Method: A case report.

Patient: A 62-year-old female.

Results: The patient presented with acutely decreased vision and a ring scotoma around her central vision three days after intravitreal triamcinolone acetonide (TRIESENCE®) injection for cystoid macular edema in her right eye (OD) secondary to birdshot chorioretinopathy. She had undergone pars plana vitrectomy, cataract extraction, and secondary intraocular lens implantation OD three months prior to the recent injection. Best-corrected visual acuity (BCVA) was 20/1000 OD and 20/50 OS. Intraocular pressure was 21 mmHg OD and 12 mmHg OS. Fluorescein angiography demonstrated a hypofluorescent area in the perifoveal zone OD. Optical coherence tomography OD depicted hyperreflective areas in the outer nuclear layer, outer plexiform layer, and retinal pigment epithelium. We diagnosed her with AMN OD and started her on brimonidine three times a day OD. She came back a week later with resolved scotoma and her vision improved to 20/60 OD. Five weeks later, BCVA was 20/40 and Intraocular pressures (IOP) was 12 mmHg OD.

Conclusions and importance: Intravitreal triamcinolone injection may be a cause of AMN with cystoid macular edema (CME) and borderline-high intraocular pressure. Brimonidine may be an effective treatment for these patients in the early course of the disease.

Keywords: AMN; Acute macular neuroretinopathy; birdshot chorioretinopathy; cystoid macular edema; dexamethasone; triamcinolone acetonide.

Publication types

  • Case Reports

MeSH terms

  • Birdshot Chorioretinopathy / complications
  • Female
  • Glucocorticoids / adverse effects
  • Humans
  • Intravitreal Injections
  • Macular Edema* / diagnosis
  • Macular Edema* / drug therapy
  • Macular Edema* / etiology
  • Middle Aged
  • Tomography, Optical Coherence
  • Treatment Outcome
  • Triamcinolone Acetonide / therapeutic use
  • Vitreous Body
  • White Dot Syndromes*


  • Triamcinolone Acetonide
  • Glucocorticoids