Intravitreal Injection of Triamcinolone Acetonide (TA) for the Treatment of Retinal and Choroidal Detachment Caused by Idiopathic Orbital Inflammation

Intravitreal Injection of Triamcinolone Acetonide (TA) for the Treatment of Retinal and Choroidal Detachment Caused by Idiopathic Orbital Inflammation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Intravitreal Injection of Triamcinolone Acetonide (TA) for the Treatment of Retinal and Choroidal Detachment Caused by Idiopathic Orbital Inflammation Xiaping Wang, Weiwei Du, Hua Fan, Shuangnong Li, Yanjie Li This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6137263/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Idiopathic orbital inflammation (IOI) is a benign, space - occupying orbital lesion with no identifiable local or systemic cause that affects the orbit. The inflammation associated with IOI can induce choroidal edema and subretinal fluid accumulation, which in turn contribute to retinal and choroidal detachments. This report details a case of recurrent IOI complicated by cataract, presenting as a shallow anterior chamber accompanied by retinal and choroidal detachment. After cataract surgery and intravitreal injection of triamcinolone acetonide (TA), favorable therapeutic outcomes were obtained. Case presentation: The authors highlight the treatment of recurrent IOI complicated with cataracts, shallow anterior chamber, choroidal detachment, and retinal detachment. Initially, a 10 - day course of steroid therapy was administered, which included oral intake, topical steroid eye drops, and parabulbar dexamethasone injections. However, the response to this treatment was insufficient. Consequently, cataract phacoemulsification and intravitreal injection of triamcinolone acetonide (TA) were carried out. Post - treatment, during the follow - up period, the patient's visual acuity improved, and the choroid and retina reattached. Conclusions : For patients with retinal and choroidal detachment induced by IOI and concomitant cataract, cataract surgery in combination with intravitreal injection of TA is capable of effectively controlling inflammation, enhancing visual acuity, and facilitating the reattachment of the choroid and retina. Idiopathic orbital inflammation Retinal detachment Choroidal detachment Triamcinolone Acetonide Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Background Idiopathic orbital inflammation (IOI), also known as Orbital Inflammatory Pseudotumor (OIP), is a non-infectious, non-neoplastic inflammatory condition affecting the orbital tissue areas, such as the lacrimal gland, eyeball, extraocular muscles, and optic nerve[ 1 – 3 ]. It is characterized by an acute onset, presenting with various symptoms such as periorbital pain, swelling, diplopia, proptosis, limitation of eye movement, ptosis, and conjunctival congestion [ 4 , 5 ]. IOI can affect individuals of all ages, though it is more frequently observed in young to middle-aged adults. The reported incidence and prevalence rates vary across studies, reflecting its relatively rare nature[ 1 , 6 ]. Recurrence is common in idiopathic orbital inflammatory diseases, especially in bilateral cases. This report presents a recurrent case with unilateral involvement. Case presentation A 63 - year - old male presented to our clinic with the chief complaints of “blurred vision in the right eye for 3 months and swelling sensation in the right eye for more than 2 weeks”. The patient had a 13 - year history of diabetes and a 5 - year history of orbital inflammatory pseudotumor in the right eye. Currently, he was taking leflunomide tablets 20mg once a day and prednisone acetate tablets 25mg once a day for 5 consecutive years. The best corrected visual acuity (BCVA) of the right eye was hand - motion, and the intraocular pressure (IOP) was 19 mmHg. The BCVA of the left eye was 0.8, and the IOP was 15 mmHg. On ocular examination, the right eye exhibited eyelid swelling, mild proptosis, no conjunctival congestion, a clear cornea, a shallow anterior chamber, and mature cataract. The left eye presented only mild cataract without other abnormalities. B - ultrasonography of the right eye revealed retinal and choroidal detachment (Fig.1A, B). Ultrasound biomicroscopy (UBM) showed: the central depth of the anterior chamber in the right eye was approximately 0.93 mm, the iris root was bulged, the iris adhered to the inner surface of the cornea-sclera, covering the scleral spur, the anterior chamber angle was closed, and 360 - degree ciliary body detachment was present (Fig.2A, B). Orbital CT showed: soft tissue swelling anterior to the orbital septum and enlargement of the lacrimal gland in the right eye; a fusiform slightly high - density shadow at the posterior pole of the right eye, considering choroidal detachment; a hemispherical high - density shadow at the posterior pole of the right eye, considering retinal detachment (Fig.3A, B). Routine blood test was negative, erythrocyte sedimentation rate was 30 mm/h, C - reactive protein was negative. Rheumatoid factor was 53.8 IU/ml. The patient was diagnosed exudative retinal detachment, choroidal detachment, ciliary body detachment, complicated cataract in the right eye and IOI in the right eye. After 10 days of treatment including oral administration of prednisolone acetate 25 mg per day, prednisolone acetate eye drops 4 times a day and dexamethasone parabulbar injection in the right eye every other day, the BCVA of the right eye increased from hand - motion to 0.05. The anterior chamber depth increased from 0.93 mm to 2.03 mm (Fig.2C). The ciliary body was repositioned (Fig.2D), and the retinal and choroidal partially reattached (Fig.1C, D). Afterwards, phacoemulsification of cataract combined intraocular lens implantation and intravitreal injection of triamcinolone acetonide in the right eye were performed. Postoperative BCVA of the right eye improved to 0.25 with normal IOP (21mmHg). Fundus examination in the right eye showed: a white mass of triamcinolone acetonide in the vitreous cavity (Fig.4), a shallow detachment of retina was seen in OCT (Fig.5A), and no retinal tear was found, which confirmed the diagnosis of exudative retinal detachment. Postoperative 3 weeks, B- ultrasonography showed retina and choroid reattached progressively (Fig.1E, F). Postoperative 3 to 5weeks OCT showed sub-retinal fluid reduced gradually (Fig.5B, C). Postoperative 3 months follow-up, the BCVA of the right eye was 0.3, and the intraocular pressure was 14 mmHg. The intraocular lens well positioned, the vitreous was clear, and the fundus examination and B- ultrasonography showed retina and choroid attached (Fig.1G, H). OCT showed: subretinal fluid absorbed totally (Fig.5D). The orbital CT scan indicates that the swelling of the preseptal soft tissues and the enlargement of the lacrimal gland in the right eye have disappeared (Fig.3C, D). No other adverse reactions were observed during the treatment and follow-up. Discussion and Conclusions Patients with IOI often present with a variety of symptoms that can range from mild discomfort to severe visual impairment [1]. Ocular pain is a frequent complaint, which can vary in intensity and may be described as a dull ache or a sharp, stabbing sensation [1, 2]. IOI can be classified into several subtypes based on the location and extent of orbital involvement. The anterior subtype typically involves the anterior portion of the orbit, affecting structures like the lacrimal gland, eyelids, and extraocular muscles. Patients with anterior IOI might present with eyelid swelling, tenderness, and a palpable mass in the anterior orbit. Diffuse IOI, involves a more extensive area of the orbit, with inflammation spreading throughout the orbital tissues. This subtype often presents with more pronounced proptosis and more widespread symptoms. The posterior subtype of IOI predominantly affects the deeper orbital structures, including the optic nerve and the orbital apex. This may cause more severe visual impairment, such as optic neuritis, and may also present with limitations in eye movement. These clinical differences highlight the importance of careful examination and imaging in classifying IOI subtypes[7]. In this case, orbital CT imaging revealed soft - tissue swelling anterior to the orbital septum and an enlarged lacrimal gland in the right eye. Based on these findings, this case was a subtype of anterior IOI. IOI complicated by choroidal and retinal detachment has been rarely reported, incidence is 1/140[8]. Inflammation of orbital tissues can compress the superior and inferior ophthalmic veins, leading to choroidal circulatory disorders which can manifest with choroidal detachment and a shallow anterior chamber [9]. Exudative retinal detachment can also be caused by the inflammatory process[9, 10]. It is essential to recognize the association between IOI and retinal or choroidal detachment as early detection and intervention can significantly impact visual outcomes. Prompt treatment with corticosteroids is effective in resolving inflammatory symptoms and improving visual recovery. In previous case reports, systemic corticosteroid administration was mostly adopted [11]. However, the patient in this case had a long - standing history of IOI, which differed from previously reported cases. Firstly, this patient was a recurrent case and had been taking oral corticosteroid for a long time. Secondly, due to the presence of cataracts, the fundus of this patient could not be examined. Although B - ultrasound could detect the choroidal and retinal detachment, it was insufficient to fully clarify the nature of the retinal detachment. Only after a detailed postoperative examination of the fundus, during which no retinal breaks were found, could the retinal detachment be confirmed as exudative. Thirdly, after long - term oral steroid therapy and the use of local steroid (eye drops and parabulbar injections), although the symptoms improved to some extent, neither the choroidal nor the retinal detachment had fully resolved. Therefore, cataract surgery and the subsequent exclusion of rhegmatogenous retinal detachment were imperative. Considering that cataract surgery may exacerbate inflammation, an intravitreal injection of triamcinolone acetonide (TA) was administered during the cataract surgery. Triamcinolone acetonide (TA) is a synthetic medium - potency glucocorticoid. It can inhibit the synthesis and release of inflammatory mediators such as prostaglandins and leukotrienes, and reduce the aggregation and activation of inflammatory cells, thereby alleviating the inflammatory response. TA have long known to reduce inflammation and have been used for treatment of many ocular diseases. The use of intravitreal TA has been of particular interest because of its anti-inflammatory effect through the inhibition of prostaglandin and leukotriene synthesis, its antipermeability effect, and its inhibition of multiple growth factors [12]. Intravitreal injection of TA results in a higher concentration of steroid in the vitreous than systemic administration. It is more effective in reducing intraocular inflammatory factors, preventing the exacerbation of inflammation after cataract surgery, and promoting the recovery of choroidal and exudative retinal detachment. This case highlights the combined use of intravitreal injection of TA and achieved favorable results. However, no reports of using intravitreal injection of TA to treat such diseases were found in previous literature. The treatment strategy of this case provides certain guidance for retinal and choroidal detachment caused by IOI. This case highlights systemic steroid administration combined with intravitreal injection of TA to treat choroidal and exudative retinal detachment caused by IOI, and achieved favorable therapeutic effects. Abbreviations IOI: Idiopathic orbital inflammation; TA: Triamcinolone Acetonide. UBM: Ultrasound biomicroscopy OCT: Optical coherence tomography Declarations Ethics approval and consent to participate This study adhered to the tenets of the Declaration of Helsinki Consent for publication Written informed consent was obtained from the patient for publication of the case report. Availability of data and materials All data generated or analysed during this study are included in this published article. Competing interests The authors declare no competing financial interests. Funding This study was supported by the Technology Innovation Program of Hunan Province (Grant No. 2024JJ9022), and the Science Research Foundation of Aier Eye Hospital Group (Grant No. AGF2301D22 and AGF2301D21). The funding organizations had no role in the design or conduct of this research. Author Contributions Conception and design: Yanjie Li, Xiaping Wang Data collection: Xiaping Wang, Weiwei Du, Hua Fan Analysis and interpretation: Xiaping Wang, Weiwei Du, Hua Fan, Shuangnong Li Manuscript preparation: Xiaping Wang, Hua Fan, Shuangnong Li, Yanjie Li Obtained funding: Hua Fan Overall responsibility: Xiaping Wang, Weiwei Du, Hua Fan, Shuangnong Li, Yanjie Li All authors reviewed the manuscript. Acknowledgements Not applicable. References Yuen, K.S., et al., Bilateral exudative retinal detachments as the presenting features of idiopathic orbital inflammation. Clin Exp Ophthalmol, 2005. 33 (6): p. 671-4. Gacan, M., E. Papuć, and K. Rejdak, Orbital Pseudotumor − Current State of Knowledge. Wiadomości Lekarskie, 2020. 73 (4): p. 818-822. Khochtali, S., et al., [Idiopathic orbital inflammatory syndrome: Report of 24 cases]. J Fr Ophtalmol, 2018. 41 (4): p. 333-342. ROOTMAN, J., Why “orbital pseudotumour ” is no longer a useful concept. Br J Ophthalmol 1998: p. 339–340. Oldroyd, A. and H. Chinoy, Recent developments in classification criteria and diagnosis guidelines for idiopathic inflammatory myopathies. Curr Opin Rheumatol, 2018. 30 (6): p. 606-613. Lee, M.J., et al., Non-specific orbital inflammation: Current understanding and unmet needs. Prog Retin Eye Res, 2021. 81 : p. 100885. Ghumman, H., et al., A Rare Case of Adult-Onset Bilateral Nonspecific Orbital Inflammation (NSOI) With Concomitant Unilateral Third Cranial Nerve Palsy. Cureus, 2024. 16 (8): p. e67181. Blodi FC, G.J., Inflammatory pseudotumour of the orbit. British Journal of Ophthalmology, 1968. 52 : p. 79-93. Sato, Y., et al., A Case of Idiopathic Orbital Inflammation with Shallow Anterior Chamber and Choroidal Detachment. Case Rep Ophthalmol, 2020. 11 (1): p. 8-15. Kurtz, S., et al., Orbital pseudotumor presenting as acute glaucoma with choroidal and retinal detachment. Ger J Ophthalmol, 1993. 2 (1): p. 61-2. Chaudhry, I.A., et al., Unilateral optic neuritis, scleritis and exudative retinal detachment due to recurrent orbital pseudotumor. Saudi J Ophthalmol, 2012. 26 (4): p. 449-51. Wilson, C.A., et al., Treatment with intravitreal steroid reduces blood-retinal barrier breakdown due to retinal photocoagulation. Arch Ophthalmol, 1992. 110 (8): p. 1155-9. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6137263","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":445758674,"identity":"1a1a4353-e0d5-40e3-b38c-192f7d885888","order_by":0,"name":"Xiaping Wang","email":"","orcid":"","institution":"Shanxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiaping","middleName":"","lastName":"Wang","suffix":""},{"id":445758675,"identity":"dde40814-0f00-4b49-b76f-b3a1e3aced5e","order_by":1,"name":"Weiwei Du","email":"","orcid":"","institution":"Shanxi Aier Eye Hospital","correspondingAuthor":false,"prefix":"","firstName":"Weiwei","middleName":"","lastName":"Du","suffix":""},{"id":445758676,"identity":"286b1c26-4eac-43f0-aec0-a21abf459fb2","order_by":2,"name":"Hua Fan","email":"","orcid":"","institution":"Shanxi Aier Eye Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hua","middleName":"","lastName":"Fan","suffix":""},{"id":445758677,"identity":"ca2cc1f1-49ed-4214-8bc1-09c55f9d936f","order_by":3,"name":"Shuangnong Li","email":"","orcid":"","institution":"Shanxi Aier Eye Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shuangnong","middleName":"","lastName":"Li","suffix":""},{"id":445758678,"identity":"ee12f0de-b791-46e7-b488-2b5d43245365","order_by":4,"name":"Yanjie Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA80lEQVRIiWNgGAWjYBACPmYQySPBwMDMfuBAQoWEHD8hLWxwLew9iQcenLEwlmwgpAXO4jlgfPBhW0XiBoJa2HkMPxfIWMgxSCQkHEicJ8G4gYH54aMbeB3GYyw9g0fCmEEi8cCBxG0SzOYMbMbGOfi1GEjz8Egk7r8BsmWbBJtlAw+bNAEtxr+BWuobJBIMDiTOkeAxOEBYixnIlgSg94FaGiQkiNDCVmYN1GLYwN6TcCDhmISBZDMBv/DzH958m7enTh4YlYc//qipq+9nb374GJ8WBgYOAwbGHmQBZrzKQYD9AQPDD4KqRsEoGAWjYCQDAGpwQKYiAduUAAAAAElFTkSuQmCC","orcid":"","institution":"Shanxi Medical University","correspondingAuthor":true,"prefix":"","firstName":"Yanjie","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2025-03-02 03:53:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6137263/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6137263/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82052267,"identity":"9802da07-5583-4d85-a283-3ebe3aecd973","added_by":"auto","created_at":"2025-05-06 10:08:17","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":388031,"visible":true,"origin":"","legend":"\u003cp\u003eB-ultrasound of the patient's right eye showed choroidal detachment and retinal detachment at the initial diagnosis (A, B); After 10 days treatment, both retinal detachment and choroidal detachment remain evident (C, D); The 3 weeks after cataract surgery with intravitreal triamcinolone acetonide (TA) injection, choroidal detachment has disappeared, and the retinal detachment has improved (E, F); After 3 month after the operation, both the choroid and retina reattached (G, H).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6137263/v1/45176d4ce21aed3b7cc600da.png"},{"id":82053707,"identity":"408497a2-2632-49be-8c62-0746baf67395","added_by":"auto","created_at":"2025-05-06 10:16:16","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":207614,"visible":true,"origin":"","legend":"\u003cp\u003eUltrasound biomicroscopy (UBM): Before treatment, the anterior chamber depth was 0.93 mm (A), and there was circumferential ciliary body detachment (B). 10 days after treatment, the anterior chamber depth was 2.03 mm (C), and the circumferential ciliary body was reattached (D).\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6137263/v1/e34abb73d076b6cb87ace1c0.png"},{"id":82051169,"identity":"30ab91f0-41ac-4b14-9cd2-a05a7d19f82e","added_by":"auto","created_at":"2025-05-06 10:00:16","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":509517,"visible":true,"origin":"","legend":"\u003cp\u003eOrbital CT shows swelling of the pre - septal soft tissues (indicated by the arrow in A), enlargement of the lacrimal gland (indicated by the arrow in B), choroidal detachment (marked with ▲), and retinal detachment (marked with ☆) in the right eye. 3 months after the treatment, the CT scan shows that the swelling of the preseptal soft tissues and the enlargement of the lacrimal gland in the right eye have disappeared. (C, D)\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6137263/v1/5ee92dbc48dc9c5584cb4e3e.png"},{"id":82051177,"identity":"27f273f9-541f-411e-a3fd-6dd2c6d6973f","added_by":"auto","created_at":"2025-05-06 10:00:17","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":365665,"visible":true,"origin":"","legend":"\u003cp\u003eScanning Laser Ophthalmoscope (SLO) on the first day after surgery.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6137263/v1/4d3e3b83d5096d8c05ddc0b3.png"},{"id":82052268,"identity":"70a23b7f-85e3-4902-8e46-ed93d59ec89c","added_by":"auto","created_at":"2025-05-06 10:08:17","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":348649,"visible":true,"origin":"","legend":"\u003cp\u003eOptical Coherence Tomography (OCT): The first day after surgery (A), 3 weeks after surgery (B), 5 weeks after cataract surgery(C), 3 months after surgery(D).\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-6137263/v1/a4ff79ccf5e137cebfcfec0e.png"},{"id":83024678,"identity":"878de30e-ac37-4d93-b0c6-12937943af9f","added_by":"auto","created_at":"2025-05-19 08:08:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2423159,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6137263/v1/0b8ee18e-ce70-484d-b4d1-2fb7ff560bb4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Intravitreal Injection of Triamcinolone Acetonide (TA) for the Treatment of Retinal and Choroidal Detachment Caused by Idiopathic Orbital Inflammation","fulltext":[{"header":"Background","content":"\u003cp\u003eIdiopathic orbital inflammation (IOI), also known as Orbital Inflammatory Pseudotumor (OIP), is a non-infectious, non-neoplastic inflammatory condition affecting the orbital tissue areas, such as the lacrimal gland, eyeball, extraocular muscles, and optic nerve[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. It is characterized by an acute onset, presenting with various symptoms such as periorbital pain, swelling, diplopia, proptosis, limitation of eye movement, ptosis, and conjunctival congestion [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. IOI can affect individuals of all ages, though it is more frequently observed in young to middle-aged adults. The reported incidence and prevalence rates vary across studies, reflecting its relatively rare nature[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Recurrence is common in idiopathic orbital inflammatory diseases, especially in bilateral cases. This report presents a recurrent case with unilateral involvement.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 63 - year - old male presented to our clinic with the chief complaints of \u0026ldquo;blurred vision in the right eye for 3 months and swelling sensation in the right eye for more than 2 weeks\u0026rdquo;. The patient had a 13 - year history of diabetes and a 5 - year history of orbital inflammatory pseudotumor in the right eye. Currently, he was taking leflunomide tablets 20mg once a day and prednisone acetate tablets 25mg once a day for 5 consecutive years. The best corrected visual acuity (BCVA) of the right eye was hand - motion, and the intraocular pressure (IOP) was 19 mmHg. The BCVA of the left eye was 0.8, and the IOP was 15 mmHg.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOn ocular examination, the right eye exhibited eyelid swelling, mild proptosis, no conjunctival congestion, a clear cornea, a shallow anterior chamber, and mature cataract. The left eye presented only mild cataract without other abnormalities. B - ultrasonography of the right eye revealed retinal and choroidal detachment (Fig.1A, B). Ultrasound biomicroscopy (UBM) showed: the central depth of the anterior chamber in the right eye was approximately 0.93 mm, the iris root was bulged, the iris adhered to the inner surface of the cornea-sclera, covering the scleral spur, the anterior chamber angle was closed, and 360 - degree ciliary body detachment was present (Fig.2A, B). Orbital CT showed: soft tissue swelling anterior to the orbital septum and enlargement of the lacrimal gland in the right eye; a fusiform slightly high - density shadow at the posterior pole of the right eye, considering choroidal detachment; a hemispherical high - density shadow at the posterior pole of the right eye, considering retinal detachment (Fig.3A, B). Routine blood test was negative, erythrocyte sedimentation rate was 30 mm/h, C - reactive protein was negative. Rheumatoid factor was 53.8 IU/ml.\u003cbr\u003e\u0026nbsp;The patient was diagnosed exudative retinal detachment, choroidal detachment, ciliary body detachment, complicated cataract in the right eye and IOI in the right eye. After 10 days of treatment including oral administration of prednisolone acetate 25 mg per day, prednisolone acetate eye drops 4 times a day and dexamethasone parabulbar injection in the right eye\u0026nbsp;every other day, the BCVA of the right eye increased from hand - motion to 0.05. The anterior chamber depth increased from 0.93 mm to 2.03 mm (Fig.2C). The ciliary body was repositioned (Fig.2D), and the retinal and choroidal partially reattached (Fig.1C, D). Afterwards, phacoemulsification of cataract combined intraocular lens implantation and intravitreal injection of triamcinolone acetonide in the right eye were performed. Postoperative BCVA of the right eye improved to 0.25 with normal IOP (21mmHg). Fundus examination in the right eye showed: a white mass of triamcinolone acetonide in the vitreous cavity (Fig.4), a shallow detachment of retina was seen in OCT (Fig.5A), and no retinal tear was found, which confirmed the diagnosis of exudative retinal detachment.\u003cbr\u003e\u0026nbsp;Postoperative 3 weeks, B- ultrasonography showed retina and choroid reattached progressively (Fig.1E, F). Postoperative 3 to 5weeks OCT showed sub-retinal fluid reduced gradually (Fig.5B, C). Postoperative 3 months follow-up, the BCVA of the right eye was 0.3, and the intraocular pressure was 14 mmHg. The intraocular lens well positioned, the vitreous was clear, and the fundus examination and B- ultrasonography showed retina and choroid attached (Fig.1G, H). OCT showed: subretinal fluid absorbed totally (Fig.5D). The orbital CT scan indicates that the swelling of the preseptal soft tissues and the enlargement of the lacrimal gland in the right eye have disappeared (Fig.3C, D). No other adverse reactions were observed during the treatment and follow-up.\u003c/p\u003e"},{"header":"Discussion and Conclusions","content":"\u003cp\u003ePatients with IOI often present with a variety of symptoms that can range from mild discomfort to severe visual impairment [1]. Ocular pain is a frequent complaint, which can vary in intensity and may be described as a dull ache or a sharp, stabbing sensation [1, 2].\u0026nbsp;IOI can be classified into several subtypes based on the location and extent of orbital involvement. The anterior subtype typically involves the anterior portion of the orbit, affecting structures like the lacrimal gland, eyelids, and extraocular muscles. Patients with anterior IOI might present with eyelid swelling, tenderness, and a palpable mass in the anterior orbit. Diffuse IOI, involves a more extensive area of the orbit, with inflammation spreading throughout the orbital tissues. This subtype often presents with more pronounced proptosis and more widespread symptoms. The posterior subtype of IOI predominantly affects the deeper orbital structures, including the optic nerve and the orbital apex. This may cause more severe visual impairment, such as optic neuritis, and may also present with limitations in eye movement. These clinical differences highlight the importance of careful examination and imaging in classifying IOI subtypes[7]. In this case, orbital CT imaging revealed soft - tissue swelling anterior to the orbital septum and an enlarged lacrimal gland in the right eye. Based on these findings, this case was a subtype of anterior IOI.\u003c/p\u003e\n\u003cp\u003eIOI complicated by choroidal and retinal detachment has been rarely reported, incidence is 1/140[8]. Inflammation of orbital tissues can compress the superior and inferior ophthalmic veins, leading to choroidal circulatory disorders which can manifest with choroidal detachment and a shallow anterior chamber [9]. Exudative retinal detachment can also be caused by the inflammatory process[9, 10]. It is essential to recognize the association between IOI and retinal or choroidal detachment as early detection and intervention can significantly impact visual outcomes.\u0026nbsp;Prompt treatment with corticosteroids is effective in resolving inflammatory symptoms and improving visual recovery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn previous case reports, systemic corticosteroid administration was mostly adopted [11]. However, the patient in this case had a long - standing history of IOI, which differed from previously reported cases. Firstly, this patient was a recurrent case and had been taking oral corticosteroid for a long time. Secondly, due to the presence of cataracts, the fundus of this patient could not be examined. Although B - ultrasound could detect the choroidal and retinal detachment, it was insufficient to fully clarify the nature of the retinal detachment. Only after a detailed postoperative examination of the fundus, during which no retinal breaks were found, could the retinal detachment be confirmed as exudative. Thirdly, after long - term oral steroid therapy and the use of local steroid (eye drops and parabulbar injections), although the symptoms improved to some extent, neither the choroidal nor the retinal detachment had fully resolved. Therefore, cataract surgery and the subsequent exclusion of rhegmatogenous retinal detachment were imperative. Considering that cataract surgery may exacerbate inflammation, an intravitreal injection of triamcinolone acetonide (TA) was administered during the cataract surgery.\u003c/p\u003e\n\u003cp\u003eTriamcinolone acetonide (TA) is a synthetic medium - potency glucocorticoid. It can inhibit the synthesis and release of inflammatory mediators such as prostaglandins and leukotrienes, and reduce the aggregation and activation of inflammatory cells, thereby alleviating the inflammatory response. TA have long known to reduce inflammation and have been used for treatment of many ocular diseases.\u0026nbsp;The use of intravitreal TA has been of particular interest because of its anti-inflammatory effect through the inhibition of prostaglandin and leukotriene synthesis, its antipermeability effect, and its inhibition of multiple growth factors [12].\u003c/p\u003e\n\u003cp\u003eIntravitreal injection of TA results in a higher concentration of steroid in the vitreous than systemic administration. It is more effective in reducing intraocular inflammatory factors, preventing the exacerbation of inflammation after cataract surgery, and promoting the recovery of choroidal and exudative retinal detachment. This case highlights the combined use of intravitreal injection of TA and achieved favorable results. However, no reports of using intravitreal injection of TA to treat such diseases were found in previous literature. The treatment strategy of this case provides certain guidance for retinal and choroidal detachment caused by IOI.\u003c/p\u003e\n\u003cp\u003eThis\u0026nbsp;case highlights systemic steroid administration combined with intravitreal injection of TA to treat choroidal and exudative retinal detachment caused by IOI, and achieved favorable therapeutic effects.\u0026nbsp;\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eIOI: Idiopathic orbital inflammation;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTA: Triamcinolone Acetonide.\u003c/p\u003e\n\u003cp\u003eUBM: Ultrasound biomicroscopy\u003c/p\u003e\n\u003cp\u003eOCT: Optical coherence tomography\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cstrong\u003e\u003cbr\u003e\u003c/strong\u003eThis study adhered to the tenets of the Declaration of Helsinki\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication of the case report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing financial interests.\u003c/p\u003e\n\u003cp id=\"_Toc472330566\"\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Technology Innovation Program of Hunan Province (Grant No. 2024JJ9022), and the Science Research Foundation of Aier Eye Hospital Group (Grant No. AGF2301D22 and AGF2301D21). The funding organizations had no role in the design or conduct of this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConception and design: Yanjie Li, Xiaping Wang\u003c/p\u003e\n\u003cp\u003eData collection: Xiaping Wang, Weiwei Du, Hua Fan\u003c/p\u003e\n\u003cp\u003eAnalysis and interpretation: Xiaping Wang, Weiwei Du, Hua Fan, Shuangnong Li\u003c/p\u003e\n\u003cp\u003eManuscript preparation: Xiaping Wang, Hua Fan, Shuangnong Li, Yanjie Li\u003c/p\u003e\n\u003cp\u003eObtained funding: Hua Fan\u003c/p\u003e\n\u003cp\u003eOverall responsibility: Xiaping Wang, Weiwei Du, Hua Fan, Shuangnong Li, Yanjie Li\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eYuen, K.S., et al., \u003cem\u003eBilateral exudative retinal detachments as the presenting features of idiopathic orbital inflammation.\u003c/em\u003e Clin Exp Ophthalmol, 2005. \u003cstrong\u003e33\u003c/strong\u003e(6): p. 671-4.\u003c/li\u003e\n \u003cli\u003eGacan, M., E. Papuć, and K. Rejdak, \u003cem\u003eOrbital Pseudotumor \u0026minus; Current State of Knowledge.\u003c/em\u003e Wiadomości Lekarskie, 2020. \u003cstrong\u003e73\u003c/strong\u003e(4): p. 818-822.\u003c/li\u003e\n \u003cli\u003eKhochtali, S., et al., \u003cem\u003e[Idiopathic orbital inflammatory syndrome: Report of 24 cases].\u003c/em\u003e J Fr Ophtalmol, 2018. \u003cstrong\u003e41\u003c/strong\u003e(4): p. 333-342.\u003c/li\u003e\n \u003cli\u003eROOTMAN, J., \u003cem\u003eWhy\u0026nbsp;\u003c/em\u003e\u003cem\u003e\u0026ldquo;orbital pseudotumour\u003c/em\u003e\u003cem\u003e\u0026rdquo; is no longer a useful concept.\u003c/em\u003e Br J Ophthalmol 1998: p. 339\u0026ndash;340.\u003c/li\u003e\n \u003cli\u003eOldroyd, A. and H. Chinoy, \u003cem\u003eRecent developments in classification criteria and diagnosis guidelines for idiopathic inflammatory myopathies.\u003c/em\u003e Curr Opin Rheumatol, 2018. \u003cstrong\u003e30\u003c/strong\u003e(6): p. 606-613.\u003c/li\u003e\n \u003cli\u003eLee, M.J., et al., \u003cem\u003eNon-specific orbital inflammation: Current understanding and unmet needs.\u003c/em\u003e Prog Retin Eye Res, 2021. \u003cstrong\u003e81\u003c/strong\u003e: p. 100885.\u003c/li\u003e\n \u003cli\u003eGhumman, H., et al., \u003cem\u003eA Rare Case of Adult-Onset Bilateral Nonspecific Orbital Inflammation (NSOI) With Concomitant Unilateral Third Cranial Nerve Palsy.\u003c/em\u003e Cureus, 2024. \u003cstrong\u003e16\u003c/strong\u003e(8): p. e67181.\u003c/li\u003e\n \u003cli\u003eBlodi FC, G.J., \u003cem\u003eInflammatory pseudotumour of the orbit.\u003c/em\u003e British Journal of Ophthalmology, 1968. \u003cstrong\u003e52\u003c/strong\u003e: p. 79-93.\u003c/li\u003e\n \u003cli\u003eSato, Y., et al., \u003cem\u003eA Case of Idiopathic Orbital Inflammation with Shallow Anterior Chamber and Choroidal Detachment.\u003c/em\u003e Case Rep Ophthalmol, 2020. \u003cstrong\u003e11\u003c/strong\u003e(1): p. 8-15.\u003c/li\u003e\n \u003cli\u003eKurtz, S., et al., \u003cem\u003eOrbital pseudotumor presenting as acute glaucoma with choroidal and retinal detachment.\u003c/em\u003e Ger J Ophthalmol, 1993. \u003cstrong\u003e2\u003c/strong\u003e(1): p. 61-2.\u003c/li\u003e\n \u003cli\u003eChaudhry, I.A., et al., \u003cem\u003eUnilateral optic neuritis, scleritis and exudative retinal detachment due to recurrent orbital pseudotumor.\u003c/em\u003e Saudi J Ophthalmol, 2012. \u003cstrong\u003e26\u003c/strong\u003e(4): p. 449-51.\u003c/li\u003e\n \u003cli\u003eWilson, C.A., et al., \u003cem\u003eTreatment with intravitreal steroid reduces blood-retinal barrier breakdown due to retinal photocoagulation.\u003c/em\u003e Arch Ophthalmol, 1992. \u003cstrong\u003e110\u003c/strong\u003e(8): p. 1155-9.\u003cstrong\u003e\u003cbr\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Idiopathic orbital inflammation, Retinal detachment, Choroidal detachment, Triamcinolone Acetonide","lastPublishedDoi":"10.21203/rs.3.rs-6137263/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6137263/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eIdiopathic orbital inflammation (IOI) is a benign, space - occupying orbital lesion with no identifiable local or systemic cause that affects the orbit. The inflammation associated with IOI can induce choroidal edema and subretinal fluid accumulation, which in turn contribute to retinal and choroidal detachments. This report details a case of recurrent IOI complicated by cataract, presenting as a shallow anterior chamber accompanied by retinal and choroidal detachment. After cataract surgery and intravitreal injection of triamcinolone acetonide (TA), favorable therapeutic outcomes were obtained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation: \u003c/strong\u003eThe authors highlight the treatment of recurrent IOI complicated with cataracts, shallow anterior chamber, choroidal detachment, and retinal detachment. Initially, a 10 - day course of steroid therapy was administered, which included oral intake, topical steroid eye drops, and parabulbar dexamethasone injections. However, the response to this treatment was insufficient. Consequently, cataract phacoemulsification and intravitreal injection of triamcinolone acetonide (TA) were carried out. Post - treatment, during the follow - up period, the patient's visual acuity improved, and the choroid and retina reattached.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: For patients with retinal and choroidal detachment induced by IOI and concomitant cataract, cataract surgery in combination with intravitreal injection of TA is capable of effectively controlling inflammation, enhancing visual acuity, and facilitating the reattachment of the choroid and retina.\u003c/p\u003e","manuscriptTitle":"Intravitreal Injection of Triamcinolone Acetonide (TA) for the Treatment of Retinal and Choroidal Detachment Caused by Idiopathic Orbital Inflammation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-06 10:00:12","doi":"10.21203/rs.3.rs-6137263/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e7d25e72-1893-47f2-869d-207738ee32ed","owner":[],"postedDate":"May 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-05-19T08:08:13+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-06 10:00:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6137263","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6137263","identity":"rs-6137263","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}