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Shawn Agee, Robert Wang, Richard Winslow; Visual Acuity Outcomes in Patients Undergoing Epiretinal Membrane (ERM) and Internal Limiting Membrane (ILM) Peel With and Without Intraoperative Intraocular Triamcinolone. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3324.
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© ARVO (1962-2015); The Authors (2016-present)
To determine if those who underwent vitrectomy for idiopathic ERM with peeling ILM along with administration of intravitreal triamcinolone resulted in improved final visual acuity outcomes compared to those not receiving intraocular triamcinolone at the end of the case.
A retrospective review of medical records for those who underwent vitrectomy with ERM and ILM peeling. Patients included had an idiopathic ERM, vision worse than or equal to 20/60, and returned for at least 12 months of follow up postoperatively. Patients with visual acuity better than 20/60, insufficient follow up, previous vitrectomy, or secondary ERM were excluded from the study. The injection group received intravitreal injections of 0.1cc triamcinolone (Kenalog-40; Bristol Myers Squibb, Princeton, NJ) with the supernatant removed at the end of the case for biologic purposes, where as the control group did not receive any intravitreal steroids. Statistical analysis was performed using independent sample T-tests as well as Mann-Whitney U-tests using MedCalc Software 188.8.131.52 (Mariakerke, Belgium). P values of less than 0.05 were considered statistically significant.
Fifty-eight eyes of 58 patients met the inclusion criteria. The injection group contained 27 eyes and the control group had 31 eyes. There were no statistically significant differences among the preoperative demographics between the two groups. The preoperative average visual acuity in the injection group was 0.66 logMAR, 0.56 logMAR at 1 month, 0.53 logMAR at 3 months, 0.49 logMAR at 6 months, and 0.38 logMAR at 12 months. The baseline/preoperative average visual acuity in the control group was 0.64 logMAR, 0.56 logMAR at 1 month, 0.49 logMAR at 3 months, 0.44 logMAR at 6 months, and 0.40 logMAR at 12 months. Analysis of the data shows that there was no statistically significant difference in the visual acuity at the 12 month endpoint, P=0.8.
Surgery for epiretinal membrane has been the treatment of choice since the 1980’s, but new techniques and medical adjuvants have allowed for better outcomes, both anatomically and functionally. Further studies looking at higher intraocular steroid concentrations or perhaps sustained release inserts of steroids may provide better final visual acuity outcomes in those undergoing epiretinal membrane removal.
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