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A. Prasad, G.K. Shah; Visual Outcomes of Vitrectomy for Recalcitrant Macular Edema Following Intravitreal Triamcinolone . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1456.
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To evaluate the efficacy of vitrectomy in eyes with recurring and persistent macular edema following intravitreal triamcinolone.
Twenty–one eyes of nineteen patients with diffuse macular edema refractory to intravitreal triamcinolone that underwent vitrectomy with internal limiting membrane peeling were retrospectively analyzed. The main outcome measure was change in visual acuity.
The study group included 13 eyes with diabetic macular edema, 5 eyes with macular edema due to a retinal vein occlusion, and 3 eyes with pseudophakic cystoid macular edema. Mean follow–up from initial intravitreal triamcinolone injection was 15.2 months (range, 7–26 months). Mean follow up following vitrectomy was 8.2 months (range, 1.5–20 months). Mean logmar visual acuity prior to intravitreal triamcinolone was –0.84. The number of intravitreal triamcinolone injections prior to vitrectomy was one in fourteen patients, two in five patients, and three in two patients. Mean logmar visual acuity prior to vitrectomy was –0.92. Mean logmar visual acuity at final follow up was –0.82. Ten eyes required further treatment for recurrent macular edema after vitrectomy with focal laser, periocular steroids, or intraocular steroids. One eye underwent repeat vitrectomy for vitreous hemorrhage. Ten eyes had evidence of macular traction on OCT prior to vitrectomy, seven of which were attributable to an epiretinal membrane. Of these ten eyes, five had resolution of macular edema following vitrectomy with no need for further treatment. Following vitrectomy, eight of the eyes gained at least two lines of Snellen visual acuity, seven remained within two lines of pre–vitrectomy visual acuity, and six eyes lost at least two lines of visual acuity. At final follow up, best corrected visual acuity was limited by cataract in two patients, and by vitreous hemorrhage in one patient.
Vitrectomy may be beneficial for eyes with macular edema that is refractory to intravitreal triamcinolone. Vitrectomy with internal limiting membrane peeling may improve macular edema in eyes with evidence of macular traction. A larger, randomized clinical trial is justified to further investigate the effectiveness of vitrectomy in the management of eyes with recurrent and persistent macular edema following intravitreal triamcinolone.
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