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H.K. Kang, C.P. R. Williams, R. Newsom, A. Luff, C. Canning; Effects of Intravitreal Triamcinolone on the Rate of Visual Recovery After Epiretinal Membrane Surgery . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1453.
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© ARVO (1962-2015); The Authors (2016-present)
Epiretinal membrane peeling is frequently associated with slow visual recovery, often taking many months to realise improved vision. Indeed, the visual acuity may be reduced compared to baseline in the early post–operative period.
To assess whether intravitreal injection of triamcinolone acetonide (IVTA) hastens the visual recovery after epiretinal membrane surgery.
Records of 44 consecutive patients, who underwent surgery for idiopathic epiretinal membrane at a teaching hospital eye unit during a 12 month period, were retrospectively reviewed. In all patients, standard 3–port pars plana vitrectomy and dye–assisted epiretinal membrane peel was performed. In seventeen eyes, 4 mg of triamcinolone acetonide was injected intravitreally at the completion of the procedure. Post–operative visual acuity (VA) at 6 weeks, and OCT foveal thickness measurements, were noted.
The two groups (IVTA and No–IVTA) were comparable in terms of baseline VA, foveal thickness, age and sex distribution. In IVTA group, the mean ± SD logMAR VA improved from 0.539 ± 0.165 at baseline to 0.328 ± 0.191 at 6 weeks (t–test for dependent variables, p = 0.0001), while no significant difference was found in No–IVTA group (0.432 ± 0.374 vs. 0.376 ± 0.251, p = 0.405). The VA improved by two or more lines in 8 (47 %) eyes in IVTA group compared to 4 (15%) eyes in No–IVTA group (chi–square test, p = 0.019). OCT measurements were available in 9 patients in IVTA group and 7 patients in No–IVTA group. The mean reduction in foveal thickness in IVTA group was significantly greater than in No–IVTA group (t–test, 94 ± 53.1 vs. 54 ± 19.4 µm, p = 0.024). IOP of 30 mm Hg or greater was seen in 3 (17.7 %) of IVTA and 2 (7.4 %) of No–IVTA patients (chi–square test, p = 0.297), all of whom responded to topical therapy. Postoperative retinal detachment occurred in 2 (11.8 %) eyes in IVTA group and in 3 (12.5 %) eyes in No–IVTA groups. None of the cases developed endophthalmitis.
Intraoperative IVTA appears to be safe, and to hasten visual recovery after epiretinal membrane surgery. The effect may be due to a reduction in surgically induced macular oedema.
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