Triamcinolone Acetonide–Assisted Vitrectomy for Idiopathic Macular Pucker: Anatomical and Functional Outcome

Abstract

Purpose: : To compare anatomical and functional outcome after surgery for idiopathic macular pucker either with or without the intraoperative application of triamcinolone acetonide (TA).

Methods: : Forty–six eyes of 46 consecutive patients, 27 women and 19 men, were prospectively analyzed. Patients were randomized into two groups: group 1 (n = 23) using TA, and group 2 (n = 23) without TA. For statistical analysis, macular thickness, measured with optical coherence tomography, and best–corrected visual acuity (BCVA) were evaluated before surgery and at the last examination. Surgery consisted of three–port pars plana vitrectomy and removal of epiretinal tissue and internal limiting membrane. In 16 patients (7 in group 1 and 9 in group 2) phacoemulsification + IOL implantation was combined to vitrectomy. No other modification of the surgical procedure, except the use of triamcinolone acetonide was made between the two groups.

Results: : Mean age was 72 years in group 1 and 69 years in group 2. Mean follow–up time was 9 months in group 1 and 10 months in group 2. Both groups of patients experienced a significant decrease of mean macular thickness from 450 ± 123 µm to 263 ± 79 µm in group 1 (P < 0.0001; t–test) and from 456 ± 93 µm to 303 ± 99 µm in group 2 (P < 0.0001). Mean BCVA was 0.35 ± 0.14 in group 1 and 0.37 ± 0.17 in group 2 before surgery. After surgery, final mean BCVA had increased to 0.57 ± 0.29 in group 1 (P = 0.003) and 0.56 ± 0.30 in group 2 (P = 0.001). No statistically significant difference was found for mean macular thickness change (P = 0.172) and mean BCVA improvement (P = 0.557) between the groups. An increase in the visual acuity (gain of 0.2 or more) was seen in 12 patients (52%) in both groups. No significant recurrence of macular pucker was found. No TA–related adverse effects were observed.

Conclusions: : Triamcinolone acetonide–assisted vitrectomy for idiopathic macular pucker appears to have favorable anatomical and functional outcomes after short follow–up.

Keywords: clinical (human) or epidemiologic studies: outcomes/complications • vitreoretinal surgery