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I. Takasu, F. Shiraga, H. Otsuki; Triamcinolone Acetonide–Assisted Internal Limiting Membrane Peeling in Macular Hole Surgery . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5423.
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Purpose: We reported that triamcinolone acetonide (TA) could be an aid to internal limiting membrane (ILM) peeling during macular hole surgery. Thus, we evaluated surgical outcomes of macular hole surgery with TA–assisted ILM peeling. Methods: Twenty five eyes of 25 consecutive patients with idiopathic macular hole, aged 42 to 77 years, underwent vitrectomy between July 2003 and June 2004. Five,13 and 7eyes respectively had stage 2,3 and 4 macular holes. TA was injected after removing the posterior hyaloid. After TA particles settled onto retinal surface, the ILM around the hole 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. Results: Although the ILM is not stained with TA, the inner surface of the retina, on which TA white particles settled, was visible clearly and stripped easily. During ILM peeling, the ILM–peeled area could be distinguished as a plain face from the non–peeled area where white particles were stuck. In 24 of 25 eyes macular holes were closed. The remaining one patient could not keep prone position after surgery. Best–corrected visual acuity improved by two or more lines in 22 eyes and stabilized in 3 of 25 eyes at 6 months after surgery. The mean visual acuity significantly improved from 0.17 preoperatively to 0.48 at 6 month postoperatively. Postoperative ocular hypertension (OH) lasted 2 days in 2 eyes and 3 months in one eye of a steroid responder. No adverse effects of corticosteroid except OH have not been seen in any eyes so far. Conclusions: TA could be an aid to ILM peeling during macular hole surgery. Although further studies are needed, TA–assisted ILM peeling could be effective in the anatomical succes and visual improvement in macular hole surgery.
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