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J.A. Dovich, M. Rauser; The Role of Intraoperative Pars Plana Intravitreal Kenalog Injection During Cataract Extraction in Patients With Preoperative Clinically Significant Diabetic Macular Edema . Invest. Ophthalmol. Vis. Sci. 2005;46(13):783.
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Purpose: We report the visual outcomes and reduction in macular edema noted in patients with clinically significant diabetic macular edema (CSDME) undergoing pars plana intravitreal kenalog injections during cataract extraction with intraocular lens implantation. Methods: A retrospective analysis was performed on 7 cases of clinically significant diabetic macular edema in which pars plana intravitreal kenalog injections were performed intraoperatively at the time of cataract extraction with intraocular lens implantation over a 17–month period. Indications for the procedure were the presence of a visually significant cataract, difficulty with treating the macular edema due to cataract, and the presence of diffuse macular leakage on preoperative fluorescein angiography. Preoperative and postoperative visual acuity, change in macular thickness by Ocular Coherence Tomography (OCT)(when available), and adverse events were noted. Results: Following surgery, visual acuity improved in each case by the time of their final exam with a mean follow–up time of 5.3 months. Preoperative visual acuity ranged from count fingers (CF) at 1’ – 20/400 and improved to CF at 6’ – 20/30–2 postoperatively. An improvement of ≥2 lines was seen in 5 of the 7 eyes (71%); the remaining 2 eyes improved the equivalent of 1 line. Comparison of pre and postoperative central macular thickness (CMT) was done with OCT for 3 of 7 eyes. CMT improvement was noted in 2 of 3 eyes, with mean decrease by 176.5 microns (54%). The CMT of the remaining eye increased from 347 to 469 microns (135%). One patient developed steroid induced glaucoma postoperatively, requiring medical therapy. No other adverse advents were noted. Conclusions: Intravitreal kenalog injection at the time of cataract extraction improves visual acuity and can decrease macular thickness in eyes with preoperative clinically significant diabetic macular edema and diffuse macular leakage on fluorescein angiography.
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