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K. Grant-Acquah, D. F. Kiernan, R. D. Jager, W. F. Mieler; Intraoperative Use of Kenalog for Epiretinal Membrane Removal Is Associated With Improved Visual Outcomes and Decreased Membrane Recurrence. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2131.
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The most common indication for epiretinal membrane (ERM) removal is a visual disturbance from decreased visual acuity or metamorphopsia. Kenalog staining has been used to improve visualization of the transparent vitreous gel during vitrectomy and facilitate visual confirmation of separation of the posterior hyaloid from the optic nerve head and posterior retina. This study compared the visual outcome and associated risks of ERM recurrence in patients who have previously undergone ERM removal with or without Kenalog staining of the ERM.
This was a retrospective chart review of 57 patients (59 eyes) who underwent pars plana vitrectomy and ERM removal with (n=30) and without (n=29) Kenalog staining of the membrane during surgery. Logarithim of the minimum angle of resolution visual acuity (LogMAR VA) was compared pre- and post- ERM removal and statistical analysis performed using a two-tailed paired student's t test. Chi-squared analysis was performed to determine if there was an association between use of Kenalog staining and rate of ERM recurrence. A subset of patients with ERM secondary to diabetic retinopathy was analyzed separately.
In patients who had Kenalog staining mean LogMAR VA decreased from 0.504 to 0.493 (p<0.001). In patients without Kenalog staining, mean LogMAR VA increased from 0.477 to 0.533 (p<0.001). There were 2 ERM recurrences (3.3%) within 36 months of patients who had Kenalog staining, while there were 7 recurrences in patients without Kenalog staining (11%) (p=0.054). 13 patients in our study group (22%) had ERM secondary to diabetic retinopathy, 8 of whom had Kenalog staining. In this group of patients with ERM secondary to diabetic retinopathy, there were 2 patients without Kenalog staining who developed ERM recurrence, while no patients with Kenalog staining who developed ERM recurrence (p=0.051).
In patients who underwent Kenalog staining during ERM surgery, there was a statistically significant improvement in LOGMAR VA compared with patients who had no staining during surgery. Kenalog staining during surgery was associated with a trend toward a decreased rate of ERM recurrence. Patients with ERM secondary to diabetes also trended toward a decreased rate of ERM recurrence with the use of Kenalog staining during initial ERM removal. Further studies are needed to elucidate this effect of intraoperative Kenalog.
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