AIM: To assess the long term effect of intravitreal triamcinolone acetonide (IVTA) on intraocular pressure (IOP) in patients with macular edema. METHODS: A retrospective case review was performed to identify all patients treated with IVTA at a university based retina practice between March 2003 and January 2004. Baseline IOP was calculated using the mean measurement from three previous visits and changes in IOP were followed after IVTA injection. RESULTS: A total of 35 eyes of 23 patients were identified. Each patient was injected with 0.1ml (4mg) of 40mg/ml triamcinolone acetonide. Responders were defined as mild (elevation 5-10mm Hg), moderate (11-15mm Hg), and severe (over 15mm Hg elevation) elevation in IOP from baseline. 23 of the 35 eyes (66%) were classified as IVTA responders. Mean time to IOP elevation was 42 days. Of those patients with elevated IOP, 15 (65%) required topical hypotensive treatment and one patient required trabeculectomy. Eleven (48%) patients remain on topical therapy and mean time of therapy for all IOP responders was 352 days at last follow up. Nine of ten central retina vein occlusion (CRVO) patients had an elevation in IOP classified as moderate or severe. Mean IOP elevation in the CRVO group was 12.3 mm Hg. CONCLUSIONS: Elevated intraocular pressure is a frequently observed sequela of IVTA treatment and may require long term hypotensive topical medication. Preoperative diagnosis of CRVO has a strong correlation with IOP spikes requiring treatment, an increased number of antiglaucoma medications once therapy is initiated, and in some cases, filtering surgery.

Purpose: to report a case of metastatic sclerochoroidal calcification is a rare ocular entity characterized by yellow-white irregular subretinal lesions. These lesions are caused by the deposition of calcium salts at the level of the sclera and choroid, in patients with abnormal calcium and phosphate metabolism. METHODS: CASE REPORT A 52 year-old asymptomatic woman underwent a routine ophthalmic examination. Past medical history was remarkable for end-stage renal insufficiency on haemodialysis associated with secondary hyperparathyroidism. Visual acuities, anterior segment examination and intraocular pressures were within normal limits. Fundoscopic examination revealed bilateral symmetric subretinal yellow white cluster-like lesions located above the superior vascular arcades. Fluorescein angiography, ultrasonographic and computerized tomography studies were obtained; their results confirmed our clinical diagnosis of metastatic sclerochoroidal calcification. CONCLUSION Sclerochoroidal calcification, a rare and poorly recognized disease with a characteristic pattern, should be included in the differential diagnosis of yellow-white lesions in the retina. A complete anamnesis to rule out possible calcium homeostasis abnormalities can be helpful. BACKGROUND Sclerochoroidal calcification is a rare and often misdiagnosed entity^1,2 characterized by yellow-white irregular subretinal lesions. These lesions are caused by the deposition of calcium salts at the level of the sclera and choroid, and can occur in three varieties according to its origin: metastatic, dystrophic and idiopathic. Even though several cases and series have been reported in the literature,^1-5 it remains poorly recognized and is often misdiagnosed.^2-5 Thus, increased awareness of this diagnosis is warranted.