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R Ratnakaram, C Canakis, C Livir-Rallatos, MD Conway, GA Peyman; Pars Plana Vitrectomy with Internal Limiting Membrane Peeling for Chronic Pseudophakic Cystoid Macular Edema . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3512.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To describe the effect of internal limiting membrane (ILM) peeling in patients with chronic pseudophakic cystoid macular edema (CME). Methods: Included in this interventional pilot study were 5 consecutive patients with chronic pseudophakic CME with a mean duration of 28 months after uncomplicated cataract surgery. The diagnosis of chronic CME was based on slit-lamp biomicroscopy and confirmed with intravenous fluorescein angiography (IVFA). Preoperative optical coherence tomography (OCT) was available for 1 patient; postoperative tomographs were obtained for 4 patients. Pars plana vitrectomy with indocyanine green-assisted ILM peeling was performed. The main outcome measures were best-corrected visual acuity, biomicroscopic appearance, perifoveal leakage on fluorescein angiography, and macular thickness and morphology on optical coherence tomography. Results: In a mean follow-up period of 7 months, the visual acuity improved in all patients from 20/164 at baseline to 20/61 at last follow up. On biomicroscopy, there was a decrease in the cystoid appearance and macular elevation corresponding to normalization of the macular appearance in OCT. Postoperative pigmentary changes were evident in two patients. On IVFA, there was a decrease in the area of perifoveal leakage. Chronic prior treatment with steroids was associated with partial recurrence of CME following discontinuation and the need to reestablish their use in 2 patients. Conclusion: Chronic pseudophakic CME after uncomplicated cataract extraction can benefit from pars plana vitrectomy with ILM peeling, with improvement in visual acuity, macular morphology, and angiographic leakage. In steroid-dependent patients, attempts to discontinue medications should be gradual.
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