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I. Takasu, M. Nakayama, H. Ohtsuki; Optional Method of Epiretinal Membrane Surgery With Multiple Usage of Triamcinolone Acetonide . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1481.
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To report that multiple usage of triamcinolone acetonide (TA) could be an aid to epiretinal membrane (ERM) and internal limiting membrane (ILM) peeling during ERM surgery. Thus, we evaluated surgical outcomes of ERM surgery with this method.
Fifteen eyes of 15 consecutive patients with ERM, aged 55 to 80 years, underwent vitrectomy between Janualy 2004 and December 2004. TA was injected after removing the posterior hyaloid. After TA particles settled onto retinal surface, the ERM was stripped with forceps. When the ILM still looked shrinking, TA was injected again to distinguish ILM from ERM and/or ILM–denuded area. The shrinking ILM was stripped with forceps. Best–corrected visual acuity measurement, fundus examination and optical coherence tomography were performed before and after the surgery to determine the anatomical and functional outcomes.
Relatively large TA particles were trapped in ERMs. It made the visualization of ERM better and the stripping easier. On the other hand, the ILM was not stained with TA and the particles just settled on the ILM, so they could be blown away by the flow. TA had a character additionally that the fine white powder seamed to dyeing the ILM–peeled area in cases. After the second or third injection of TA, the ILM–peeled area could be distinguished as a whitish locus from the remaining ILM on which TA particles were less stuck. It facilitated the ILM peeling if necessary in these series. Best–corrected visual acuity improved by two or more lines in 10 eyes and stabilized in 5 of 15 eyes at 12 months after surgery. The mean visual acuity significantly improved from 0.44 preoperatively to 0.73 at 12 month postoperatively. No adverse effects of corticosteroid except temporary ocular hypertention have been seen in any eyes.
TA was useful to visualize and distinguish ERM and/or ILM from the area denuded of them. Although further studies are needed, multiple usage of TA could be an aid to ERM and ILM peeling during macular surgery.
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