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Rajesh C. Rao, Kevin J. Blinder, Gaurav K. Shah; Triamcinolone-Assisted Internal Limiting Membrane Peeling During Primary Rhegmatogenous Retinal Detachment Repair Reduces Postoperative Macular Pucker Formation. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5791.
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To determine whether triamcinolone-assisted peeling of the internal limiting membrane (ILM) during uncomplicated, primary rhegmatogenous retinal detachment (RRD) repair reduces subsequent formation of, and secondary surgery for, postoperative macular pucker.
This was a retrospective, observational case series. Patient charts were selected based on coding searches of a database from July 1, 2005 to June 30, 2010 in a large retina referral practice. The primary endpoint, the presence of postoperative macular pucker formation, as assessed by clinical biomicroscopy, was compared between 32 eyes (30 patients) who underwent primary RRD repair without ILM peeling (group 1) and 30 eyes (30 patients) who underwent primary RRD repair with triamcinolone-assisted ILM peeling (group 2). All patients underwent vitrectomy. In group 1, optical coherence tomography (OCT) was used in a subset of patients to confirm the presence of macular pucker prior to surgery for macular epiretinal membrane removal. In group 2, OCT was used to confirm the presence of macular pucker.
The mean age ± standard deviation of patients was 66.1±10.5 years in group 1 and 67.5±10.2 years in group 2 (p=0.65). Baseline visual acuities were similar in both groups (p=0.43). In each group, there was a clinically and statistically significant improvement in visual acuity following RRD repair (p<10-3). The mean follow-up time ± standard deviation was 633±473 days in group 1 and 434±317 days in group 2 (p=0.06). There were no significant differences between the two groups with regard to gender (p=1.00), laterality (p=0.30), number of retinal breaks (p=0.62), macula status (p=1.00), duration from diagnosis to surgery (p=0.60), concomitant scleral buckling (p=0.29), magnitude of visual acuity improvement following RRD repair (p=0.12). In group 1, 11 of 32 patients (34.4%) developed postoperative macular pucker, with a mean Snellen acuity of 20/40. In contrast, 1 of 30 patients (3.3%) in group 2 developed pucker, whose visual acuity was 20/25, p=0.0027. Overall, 3 of 32 patients (9.4%) in group 1 underwent repeated surgery for removal of macular epiretinal membranes (mean preoperative acuity, 20/141; improving to mean 20/47 postoperatively). None of the patients in group 2 underwent surgery for postoperative macular pucker.
Triamcinolone-assisted ILM peeling during primary RRD repair reduces postoperative macular pucker formation and, in this series, eliminated the need for subsequent macular epiretinal membrane removal. In patients undergoing vitrectomy for uncomplicated, primary RRD repair, this technique may be considered.
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