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J.D. Benevento, S.M. Hariprasad, W.F. Mieler; Visual Acuity Outcomes After Epiretinal Membrane Removal Using 25 Gauge Vitrectomy and Triamcinolone Acetonide Assisted Peeling of the Internal Limiting Membrane . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4650.
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Vitrectomy with membrane peeling is commonly performed for visual loss secondary to epiretinal membranes. It is controversial whether improved outcomes can be achieved with 20 gauge versus 25 gauge vitrectomy, internal limiting membrane (ILM) peeling versus leaving the ILM intact, and use of indocyanine green versus triamcinolone acetonide assistance for peeling the ILM. Several studies have shown an improvement in visual acuity using various surgical techniques. The purpose of this study is to evaluate the results of epiretinal membrane removal using 25 gauge vitrectomy and triamcinolone acetonide assisted peeling of the internal limiting membrane.
A retrospective analysis was performed of a consecutive series of five eyes of five patients undergoing vitrectomy for treatment of epiretinal membrane. Only patients with a follow up time of 1 month or greater were included. Three eyes were phakic and two eyes were pseudophakic. Preoperative and postoperative Snellen visual acuities were recorded. Average visual acuity was calculated using logMAR notation. Surgery was performed using the Alcon Accurus 25 gauge vitrectomy system. Both the epiretinal membrane and the internal limiting membrane were sequentially peeled using 25 gauge intraocular micro–forceps. Intravitreal triamcinolone acetonide in a concentration of 10 mg/mL was used to highlight the internal limiting membrane.
The average preoperative visual acuity was 20/60–1 (logMAR–0.50, +/– 0.24, range 20/40 to 20/150). The average postoperative visual acuity was 20/30–2 (logMAR –0.24, +/–0.19, range 20/20 to 20/60). Four patients had an increase in visual acuity and one patient remained unchanged. The average change between preoperative and postoperative visual acuities was +2.8 Snellen lines. Overall, patients in this series experienced a 52% improvement in vision over an average follow up time of 57 days (range 36 to 106 days). No patient in the series had a decrease in vision or experienced any complications.
Treatment of epiretinal membrane with 25 gauge vitrectomy and triamcinolone acetonide assisted removal of the internal limiting membrane results in improvement of visual acuity. A larger series with longer follow up investigating this method of removing epiretinal membranes may be warranted
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