Membrane Peel with Simultaneous Intravitreal Triamcinolone Acetonide for the Treatment of Diffuse Diabetic Macular Edema.

Abstract

Abstract: : Purpose: Diffuse diabetic macular edema can cause metamorphopsia and decreased visual acuity secondary to retinal distortion and intraretinal edema. We propose that ILM or posterior hyaloid removal with simultaneous injection of intravitreal triamcinolone acetonide may result in improved visual acuity outcomes as well as a faster visual recovery as compared to previous reported results with membrane peeling alone. Methods: Charts of diabetic patients of the Vitreoretinal Service at the New England Eye Center who underwent pars plana vitrectomy and simultaneous injection of intravitreal triamcinolone acetonide from March 2003 until September 2003 were reviewed. We report three month follow–up visual acuity as well as optical coherence tomography measurements. Results: Fifteen patients underwent pars plana vitrectomy and either posterior hyaloid or ILM removal with simultaneous injection of intravitreal triamcinolone acetonide. Five cases were performed with a 25–gauge vitrectomy system (Dutch Ophthalmic, The Netherlands/ Alcon, Fort Worth, Texas). In many cases, alterations in the ILM were identified on OCT. In these patients, ILM peeling was performed when technicaly feasible. The average preoperative logMar visual acuity was 1.12 ± 0.41. Visual acuity 1 month postoperatively was 1.06 ± 0.52. Optical coherence tomography (OCT3) measurements revealed an average central macular thickness of 378 ± 62 µm preoperatively. One month postoperative central macular thickness was 232 ± 34 µm. No cases of sterile or infectious endophthalmitis occurred and no steroid–induced glaucoma developed. There were no surgical complications. Conclusions: Pars plana vitrectomy and either posterior hyaloid or ILM removal with simultaneous injection of intravitreal triamcinolone acetonide for diabetic epiretinal membranes may afford improved visual recovery. Case–controlled studies are necessary to assess the benefit of this combined therapy.

Keywords: vitreoretinal surgery • corticosteroids • diabetes