despite the lack of randomized , controlled trials proving its long - term safety and efficacy , intravitreal corticosteroid injections have emerged in the past decade as an increasingly used treatment for patients with macular edema secondary to diabetes mellitus , retinal vein occlusion , exudative macular degeneration , chronic uveitis and pseudophakic cystoid macular edema.1 potential complications of intravitreal corticosteroid treatment are divided into steroid - related and injection - related adverse effects . steroid - related side effects most commonly include cataract formation and an elevation in intraocular pressure ( iop ) . injection - related side effects include retinal tear , choroidal and retinal detachment , vitreous hemorrhage , bacterial endophthalmitis , non - infectious endophthalmitis , pseudo - endophthalmitis , and activation of latent infections ( such as acute syphilitic posterior placoid chorioretinitis or cytomegalovirus retinitis).211 we describe a rare case of triamcinolone acetonide entrapment in the berger 's space between the posterior lens capsule and the anterior hyaloid face after intravitreal triamcinolone acetonide ( ivta ) injection . the patient underwent neodymium : yttrium - aluminum - garnet ( nd : yag ) laser anterior hyaloidotomy , allowing the trapped fluid to flow into the vitreous cavity . a 65-year - old male with a 15-year history of type 2 diabetes mellitus presented with a complaint of blurred vision in the left eye over a 2-month period . best corrected visual acuity was 20/30 and 20/80 in the right and left eyes , respectively . fundus examination showed a bilateral moderate non - proliferative background diabetic retinopathy and a clinically significant macular edema ( csme ) in the left eye . time - domain optical coherence tomography ( stratus oct3 , carl zeiss meditec inc . , dublin , ca , usa ) showed a diffuse thickening in the macula with a foveal thickness of 630 m . there was no evidence of significant vitreomacular traction . the left eye underwent injection into the vitreous cavity of 0.1 ml ( 4.0 mg ) of a commercially available suspension of triamcinolone acetonide ( trigon depot ; 40 mg / ml , bristol - myers squibb sl , new york , ny , usa ) under aseptic conditions in the operating room . the 26-g needle was inserted perpendicular through sclera in the inferotemporal quadrant , 4 mm from the limbus , with the tip aimed toward the center of the globe ( to avoid any contact with the posterior lens ) . as a part of the routine protocol , the next day , the patient returned to our emergency department complaining of sudden decrease of vision in the left eye . visual acuity in this eye dropped to hand movements . slit - lamp examination showed the drug between the posterior capsule of the lens and the displaced anterior hyaloid membrane , within the berger 's space [ figure 1 ] . there was no view of the fundus , but an ultrasound b scan exam revealed a clear vitreous . during 2 weeks of follow - up , there was no change in the appearance of the milky fluid , and the blurred vision persisted unchanged . with the patient 's consent , an nd : the anterior face of the hyaloids was nicely outlined by the triamcinolone , allowing easily its identification . it was approximately 1 mm far from the posterior capsule . a peyman contact lens ( opyg-12/12 , ocular instruments , inc . , bellevue , wa , usa ) was applied to the eye . after a single pulse application at 2.0 mj for 1.0 ms duration aiming at the displaced anterior face of the hyaloid , the trapped triamcinolone acetonide leaked into the vitreous cavity . one week later , slit - lamp examination revealed the complete disappearance of the milky fluid [ figure 2 ] . the patient did not receive other treatments , macular thickness decreased significantly to 302 m , and no posterior subcapsular cataract was observed . slit - lamp examination showing the triamcinolone acetonide between the posterior capsule of the lens and the anterior hyaloid membrane ( berger 's space ) following intravitreal triamcinolone acetonide injection one week after performing neodymium : yttrium - aluminum - garnet laser anterior hyaloidotomy , slit - lamp examination revealed the complete disappearance of the milky fluid anterior segment problems after ivta injection are rare and include vitreous prolapse into anterior chamber with or without intraocular lens ( iol ) and decentration and opaque coating over the iol.1213 salman et al.14 reported the only case of entrapment of intravitreal triamcinolone behind the crystalline lens . in that case , the head movement at the time of injection caused the drug to be delivered into the berger 's space between the posterior lens capsule and the anterior hyaloid face . the pathogenesis of this complication is unclear . probably , the injected triamcinolone was misdirected alongside the anterior vitreous surface . a closed chamber might have formed behind the posterior lens capsule by a central detachment of the anterior hyaloid membrane still adherent to the posterior lens capsule by a fibrosed ring . the lens is usually attached to the anterior vitreous surface along a circular zone called the hyaloideocapsular ligament or ligamentum pectinatum , of approximately 12 mm in width and 89 mm in diameter.15 this circular attachment is firm in youth and weakens with age . the potential space of berger lies within the hyaloideocapsular ligament , where the vitreous is attached to the posterior aspect of the lens . this case highlights the importance of proper technique of intravitreal injections because triamcinolone acetonide may become entrapped behind the crystalline lens if the needle is not properly positioned . although both conservative approach to avoid damage to the lens and surgical removal via the pars plana were valid options , we preferred nd : yag laser anterior hyaloidotomy . it was successfully performed resulting in a dramatic increase in visual acuity and the lens remaining clear . in conclusion , nd : yag laser anterior hyaloidotomy is an effective , simple , useful and minimally invasive outpatient procedure in cases with persistent entrapment of triamcinolone acetonide behind the crystalline lens . this technique offers patient rapid recovery of visual acuity and the avoidance of more invasive surgical procedures , allowing the drug to clear without trauma to the crystalline lens . nd : yag laser posterior hyaloidotomy has been indicated for subhyaloid hemorrhages16 and premacular vitreous floaters.17 likewise , nd : yag laser anterior hyaloidotomy has been indicated for malignant glaucoma following cataract surgery.18 to the best of our knowledge , this is the first case report to document the use of nd : yag laser anterior hyaloidotomy for allowing the persistent depot of triamcinolone acetonide to flow into the vitreous cavity . a limitation of this paper is the short follow - up period of only 7 days . although no complications were observed during this time , late complications such as the progression of diabetic macular edema due to rupture of the anterior hyaloid membrane or the development of a posterior subcapsular cataract might be expected .