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G.M. Lewis, R. Morris; Treatment of Cystoid Macular Edema in Branch Retinal Vein Occlusion With Grid Photocoagulation, Intravitreal Triamcinolone, and Pneumatic Maculopexy . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5207.
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© ARVO (1962-2015); The Authors (2016-present)
To compare the efficacy and safety gas–assisted maculopexy with and without intravitreal triamcinolone to triamcinolone alone as a new alternative treatment for cystoid macular edema (CME) in branch retinal vein occlusion (BRVO).
Retrospective case series of 12 consecutive patients who underwent triamcinolone–assisted maculopexy (TAMP), gas–assisted maculopexy (GAMP), or a combination of TAMP and GAMP for nonischemic BRVO with CME. Patients were treated between February 1996 and April 2004 at Retina Specialists of Alabama (Birmingham, Alabama). Visual acuity was measured with a standard Snellen chart and converted to logarithm of the minimum angle of resolution (LogMAR) for computational purposes. Ocular Coherence Tomography II (OCT) and digital flourescein angiography with fundus photography were used on many patients. Visual acuities, intraocular pressure (IOP), and appropriate ophthalmologic examinations were performed at one week, one month and three months after injection.
Of 12 eyes that had received grid laser photocoagulation, three received TAMP alone, five received GAMP alone; and four were treated with combined–assisted maculopexy (CAMP). Patients were followed for an average of 22 months. The average final improvement in visual acuity was 0.3 lines for the TAMP–treated eyes, 2.8 lines for the GAMP–treated eyes, and 3.0 lines for the CAMP–treated eyes. 33% of the TAMP group, 80% of the GAMP group, and 75% of the CAMP group gained 2 or more lines of LogMAR visual acuity. This compares to the BRVO Study, in which 65% of patients treated with a grid pattern of photocoagulation improved by at least 2 lines of vision, and patients averaged 1.33 lines gained. The average change on OCT in central macular thickness was 180 µ and 193 µ for the TAMP and CAMP groups, respectively.The average maximum change in IOP was 11, 10, and 7 mmHg for the TAMP, GAMP, and CAMP groups respectively. No patients had significant complications.
Gas–assisted maculopexy is a safe and effective new alternative therapy for CME in BRVO. However, further studies will be needed to determine its role, possibly as an adjunctive initial treatment.
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