Triamcinolone Assisted Internal Limiting Membrane Peeling in Macular Hole Surgery

Abstract

Abstract: : Purpose: To report our experience of triamcinolone assisted internal limiting membrane (ILM) peeling for macular hole surgery. Methods: A retrospective case review of 23 consecutive patients (23 eyes) diagnosed with stage II or higher macular hole. All patients received pars plana vitrectomy and ILM peel with the use of triamcinolone followed by gas tamponade with C₃F₈, SF₆, or silicone oil. The length of face down positioning was at the discretion of the surgeon (GS, KB). Main outcome measures were anatomical closure rate of the macular holes and stabilization/improvement of vision. Cataract progression, surgical complications, glaucoma status, and intraocular pressure (IOP) change were also noted. Results: All 23 patients (18 F, 5 M, avg. age = 67 years) achieved anatomical closure of the macular hole. 20 of the 23 patients (87%) had either stabilization or improvement of their vision. All three patients that had decreased vision after surgery had significant cataract progression. 14 of 20 phakic patients (70%) had some progression of their cataracts. One patient had a retinal horseshoe break that was repaired at the time of surgery. Two patients had significant elevations of IOP (> 40 mm Hg) postoperatively that were successfully controlled with pressure lowering medication. Conclusions: Our retrospective analysis suggests that triamcinolone–assisted ILM peeling in macular hole surgery was associated with hole closure rates consistent with the reported literature. In this case review there were no significant intraoperative or postoperative complications solely related to its use.

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