Purchase this article with an account.
F. Foltran, G. Prosdocimo, G. Lo Giudice; Pars Plana Vitrectomy Combined With Intravitreal Triamcinolone Acetonide Injection for Diabetic Diffuse Macular Edema . Invest. Ophthalmol. Vis. Sci. 2005;46(13):1441.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose: To assess prospectively the efficacy and safety of combined pars plana vitrectomy (PPV) with internal limitant membrane( ILM ) peeling and intravitreal injection of triamcinolone acetonide ( TA ) for refractory diabetic diffuse macular edema. Methods: Interventional, non–randomized case series. Twenty patients with bilateral diabetic macular edema unresponsive to laser photocoagulation were evaluated. In 8 out of 20 patients a vitreomacular traction on either biomicroscopy or optic coherence tomography (OCT) was disclosed. One eye underwent surgery, and the other served as a control. Under parabulbar anesthesia a TA – assisted vitrectomy with ILM peeling followed by the intraoperative injection of 4 mg of TA were performed. Central macular thickness (CMT) measured by optical coherence tomography (OCT–3); best corrected Snellen visual acuity (BCVA); and intraocular pressure before any procedure and at 1, 6, and 12 months after surgery were evaluated. Results: All patients had a mean follow–up of 6 months (range: 3 months to 12 months). Six of them were followed for 12 months. At baseline the mean CMT was 462.5 µm in vitrectomized eyes, versus 441.4 µm in control eyes. One month after combined treatment, it was 195.2 µm in vitrectomized eyes and 482.3 µm in control eyes ( P<0.001, bilateral Wilcoxon test for paired samples ); after 6 months, 224.1 µm and 464.8 µm respectively ( P=0.005 ); and after 12 months, 251.6 µm and 458.1 µm (P=0.007), respectively. One month and 6–month after combined treatment, BCVA improved at least of 2 or more lines in 5 out of 8 patients with vitreomacular traction and in 7 out of 12 patients without vitreomacular traction; this trend was maintained in 4 of the 6 patients who followed up for 12 months. All vitrectomized eyes gained or maintained VA during the long–term follow–up. No significant improvement in VA was found between baseline and long–term follow–up in all control eyes . In 2 of 20 vitrectomized eyes, intraocular pressure exceeded 25 mmHg, and was controlled by topical medication. No other complication was detected during the follow–up. Conclusions: PPV with ILM peeling combined with intravitreal injection of TA seems to be efficacy and safety to reduce central macular thickness and improve VA in patients with diabetic diffuse macular edema, in the long term. Further studies are required.
This PDF is available to Subscribers Only