Triamcinolone–Assisted Vitrectomy for Asteroid Hyalosis

Abstract

Purpose: : To evaluate the efficacy of Triamcinolone acetonide (TA)–assisted vitrectomy for diverse vitreoretinal diseases with asteroid hyalosis (AH).

Methods: : From April 2003 to April 2004, 5 consecutive eyes, from 5 patients undergoing TA–assisted vitrectomy for AH complicated with diverse vitreoretinal diseases: macular hole; diabetic macular edema; retinitis pigmentosa; proliferative diabetic retinopathy were selected for this study. TA–assisted vitrectomies were performed at Kyushu University Hospital by different surgeons. All patients received ophthalmologic examinations including a Snellen best corrected visual acuity measurement, an intraocular pressure (IOP) measurement, stereoscopic biomicroscopy and indirect ophthalmoscopy. Preoperative posterior vitreous detachment (PVD) was determined by the presence of a Weiss ring using slit–lamp biomicroscopy. The patients’ ages ranged from 48 to 85 years, with a mean age of 69.3±10.8 years. The postoperative follow–up period ranged from 6 to 17 months, with a mean follow–up period of 11.9±6.4 months. The condition of each eye was monitored for at least 6 months.

Results: : The posterior hyaloid, which was visualized by means of a TA granule, was separated from the optic disc using the suction of a vitrectomy probe in eyes with no PVD. In 4 of the 5 eyes, the residual VC was identified with an intravitreal TA injection, which was also useful for residual VC removal. Of our 5 cases, one eye (macular hole) displayed preoperative PVD with a Weiss ring. Visual acuity was restored in all cases. Iatrogenic retinal breaks occurred and they were successfully treated in one eye that had proliferative diabetic retinopathy. In 1 out of 5 eyes, a temporary IOP elevation was observed. However it did not last longer than 1 week in any of the eyes.

Conclusions: : TA solution was useful to perform PVD because it allows for easy detection of the posterior hyaloid. The posterior hyaloid can be held with a vitrectomy probe, and it can be safely removed using this technique.

Keywords: vitreoretinal surgery • vitreous • retina