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V. A. Forsaa, L. T. Hashemi, P. Bjerga, A. Takserman, D. H. Engelsvold, S. Raeder, J. H. Seland; A Randomized Trial Comparing Combined Vitrectomy and Triamcinolone With Standard Care in Macular Edema Secondary to Branch Retinal Vein Occlusion. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4737.
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To compare the efficacy of combined pars plana vitrectomy (PPV) and triamcinolone (TA) with grid photocoagulation in eyes with macular edema (ME) secondary to branch retinal vein occlusion (BRVO).
29 participants where randomized to PPV combined with intravitreal injection of 20 mg purified TA (PPV+TA group) or grid photocoagulation (grid group). Inclusion criteria consisted of macular edema secondary to BRVO, visual acuity (VA) ≥ 0.3 logMAR, and three to 12 months duration of symptoms. When indicated, the PPV+TA group received further injections of 10 mg TA following four and eight months and the grid group additional grid photocoagulation after four months. Best corrected visual acuity (BCVA) using Early Treatment Diabetic Retinopathy Study (ETDRS) charts and optical coherence tomography measurements were obtained at baseline and at 12-month follow-up. Non-parametric statistics were used to compare the treatment groups (Mann-Whitney U test) and to compare 12 months with baseline (Wilcoxon signed-rank test).
24 patients (10 female) completed 12-month follow-up, and the treatment groups were well balanced with regard to gender, age, and duration of BRVO. The mean age was 71.4 years (range, 52.0-82.0 years). At baseline, there was no significant difference between the groups with regard to mean BCVA (p=0.44) and mean central macular thickness (CMT) (p=0.29). At 12-month follow-up, significant improvements in lines gained of logMAR BCVA in the PPV+TA group (0.82 to 0.61, p=0.01) and the grid group (0.90 to 0.68, p=0.02) were found. Converted into mean change in ETDRS letters, there was no significant difference between the PPV+TA group (10.9 letter gain) and the grid group (10.4 letter gain) (p=0.84). Furthermore, a significant reduction in CMT was seen in the PPV+TA group (591 µm to 284 µm p=0.002) and the grid-group (566 µm to 291 µm, p=0.007). Elevated intraocular pressure (IOP) (>23 mmHg) was noted in 43% of eyes in the PPV+TA group compared to 0% in the grid group. Cataract progression was registered in six out of eight phacic eyes in the PPV+TA group and in one out of five in the grid group.
Our preliminary results indicate that combined PPV+TA and grid photocoagulation show significant improvements in BCVA and reduction of CMT after 12-month follow-up. However, the treatment groups do not differ with regard to letter gain. High dose TA should be avoided due to IOP elevation and cataract progression.
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