Abstract
Abstract: :
Purpose:To determine the visual outcome and incidence of complications seen in patients with diabetic and non–diabetic macular edema treated with 4 mg of intravitreal kenalog with or without pars plana vitrectomy. Methods:The medical records of 129 patients who presented to our practice with macular edema were retrospectively reviewed. One hundred forty–three eyes (68 right) in 129 patients (65 female) were identified. Follow–up ranged from 6–30 months (mean 17 months). Eighty–eight eyes (62%) had diabetic and 55 eyes (38%) had non–diabetic macular edema. Forty–nine eyes (34%) had vitrectomy with membrane peeling in addition to the placement of intravitreal kenalog. Final visual outcome, optical coherence tomography measurements of central foveal thickness, and the incidence of raised intraocular pressure and hypopyon/fibrinoid uveitis were measured as outcome variables. Results:Presenting mean visual acuity was 20/128 and final acuity was 20/62 for all eyes (P<0.0001, paired t–test). Raised intraocular pressure was seen in 72 eyes (50%), and hypopyon/fibrinoid uveitis developed in 7 eyes (5%). Central foveal thickness decreased from 459 micrometers to 227 micrometers (P=0.0014). Final visual acuity was significantly better in eyes injected with kenalog (20/60, P<0.0001) and in eyes that had vitrectomy in association with kenalog use (20/65, P<0.0001). Final visual acuity was also significantly better in eyes with diabetic (20/62, P<0.0001) and non–diabetic (20/61, P<0.0001) macular edema. Visual acuity did not improve in eyes that developed uveitis (20/70, P=0.20). Conclusions:Intravitreal kenalog can result in a modest improvement in visual acuity and a reduction in foveal thickness in eyes with diabetic and non–diabetic macular edema. A high incidence of raised intraocular pressure and uveitis can be associated with this treatment. Eyes that develop uveitis may have worse visual outcomes.
Keywords: diabetic retinopathy • macula/fovea • vitreoretinal surgery