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F. C. DeCroos, R. Shuler, Jr., S. Stinnett, S. Fekrat; Treatment of Cystoid Macular Edema Secondary to Central Retinal Vein Occlusion With Pars Plana Vitrectomy, Internal Limiting Membrane Peeling, and Panretinal Endophotocoagulation. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2697.
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© ARVO (1962-2015); The Authors (2016-present)
Consensus does not exist for optimal treatment of eyes with persistent cystoid macular edema (CME) secondary to central retinal vein occlusion (CRVO). This study investigates visual and anatomical outcomes in eyes that underwent pars plana vitrectomy, internal limiting membrane peeling, and panretinal endophotocoagulation (PPV/MP/EL) for treatment of CME caused by CRVO.
Consecutive, nonrandomized patients at the Duke Eye Center who underwent PPV/MP/EL for treatment of refractory CME secondary to CRVO by a single surgeon (S.F.) between 9/2004 and 6/2005 were retrospectively identified and reviewed. Treatment up to 3 times with 4 mg intravitreal triamcinalone was performed prior to surgical intervention in 85% (at least 4 months prior to surgery). Inclusion criteria were vision loss > 20/160 and persistent CME on optical coherence tomography (OCT) with a foveal thickness > 300 microns. Data collected included age, perfusion status of CRVO, treatments prior to PPV/MP/EL, pre-operative lens status, change of lens status, best corrected visual acuity (BCVA), foveal thickness, and total macular volume on OCT.
Thirteen patients were identified. Duration of CRVO prior to surgery ranged from 3 to 19 months (mean, 11.6 months). Postoperatively, BCVA, foveal thickness, and total macular volume improved initially over the first 3 months. This improvement was not sustained at 6, 9, 12, and 15 months. At the time of surgery, 54% of eyes were pseudophakic. Of the remaining eyes, 100% developed visually significant cataracts within 1 year postoperatively, with 67% requiring cataract extraction within 15 months after surgery.
Retrospective review demonstrates PPV/MP/EL performed for persistent CME secondary to CRVO improved BCVA and reduced foveal thickness and total macular volume for the first 3 months postoperatively. These results however were not sustained over longer follow up intervals likely due to progressive macular ischemia. Phakic eyes were noted to have accelerated cataract progression after PPV/MP/EL, but the extent of this association is unclear in the context of pretreatment with intravitreal triamcinalone.
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