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D. S. Rudich, I. Barbazetto, S. Chang; Intravitreal Triamcinolone Acetonide Injection after Epiretinal Membrane Peeling in Diabetic and Non-diabetic Patients. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4455.
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To evaluate clinical outcomes after intravitreal injection of triamcinolone acetonide (IVTA) as an adjunctive procedure in pars plana vitrectomy following epiretinal membrane removal in diabetic and non-diabetic patients.
Retrospective, nonrandomized, comparative study of 18 consecutive patients (18 eyes) who underwent standard 23 gauge pars-plana vitrectomy with epiretinal membrane removal followed by intraocular injection of triamcinolone at the end of surgery. Patient demographics, visual acuity, intraocular pressure, measurements of macular thickness (optical coherence tomography) and the need for additional procedures, were analyzed at pre and post-operative visits.
Eighteen patients (7 male, 11 female; 8 diabetic, 10 non-diabetic) with an average age of 67.3 years (48-87 years) and a mean follow-up of 6 months (0 to 14 months) were included in the study. All patients showed features of macular edema on OCT imaging with cystic changes and an average central thickness of 452.8um (771-243um) Among diabetic patients, the mean best-corrected visual acuity (BCVA) prior to surgery was 20/60 and the mean central retinal thickness measured 457.22um. In the non-diabetic group, the BCVA pre-surgery measured 20/70 with a mean central retinal thickness measured 448.9um. Post-operatively at weeks 1-3 the average central retinal thickness decreased to 350.73um (504-213um) for all patients (diabetics: 277.67um; non-diabetics: 378.83um). One month after surgery all diabetic patients examined showed remaining cystic changes on OCT compared to 4 out of 9 patients in the non-diabetic group. Two months after surgery the mean retinal thickness measured 280.8um (325-198um) for the entire study group (261um for diabetic; 294um for non-diabetic patients. At 6 months post-operatively, central retinal thickness increased again to 392.67um (653-127) (389um for non-diabetic and 387um for diabetic patients).
Vitrectomy with IVTA resulted in reduced central foveal thickness in all patients following surgery. Although no statistically significant difference was found between diabetic versus non-diabetic patients, diabetic patients showed a trend towards a greater reduction in central retinal thickness during the first 3 weeks following the procedure.Cystic changes were more likely to resolve in diabetic patients when compared to non-diabetics. Additional prospective studies with a greater number of patients and longer follow up are needed to confirm these observations.
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