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      Triamcinolone Acetonide Facilitates Removal of the Epiretinal Membrane and Separation of the Residual Vitreous Cortex in Highly Myopic Eyes with Retinal Detachment due to a Macular Hole

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          Purpose: To study the usefulness of intravitreal triamcinolone acetonide injection during vitrectomy in highly myopic eyes with retinal detachment due to a macular hole. Methods: Pars plana vitrectomy was performed in 6 patients with retinal detachment resulting from a highly myopic eye with a macular hole. After separation of the posterior hyaloid and removal of any visible epiretinal membrane, triamcinolone acetonide was injected over the posterior pole. Excised specimens were evaluated by transmission electron microscopy. Results: Upon injection of triamcinolone acetonide, the entire epiretinal membrane and residual vitreous cortex could be visualized in all patients. The epiretinal membrane and residual posterior vitreous cortex were completely removed. Successful reattachment was performed without retinal damage in all cases. Electron microscopy revealed a cellular epiretinal membrane within a collagenous matrix lining the smooth internal surface of the internal limiting membrane. No complications related to the use of triamcinolone acetonide were encountered. Conclusion: Intraoperative visualization of the epiretinal membrane and residual posterior vitreous cortex with triamcinolone acetonide was found to be a useful adjunct to vitrectomy. Using triamcinolone acetonide during vitrectomy may facilitate both removal of the epiretinal membrane around the macular hole and separation of the residual vitreous cortex from the retina in highly myopic eyes with retinal detachment.

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          Most cited references 8

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          Intravitreal triamcinolone for uveitic cystoid macular edema: an optical coherence tomography study.

          To investigate the use of intravitreal injection of triamcinolone acetonide (TA) for the treatment of refractory uveitic cystoid macular edema (CME). Prospective, nonrandomized, self-controlled comparative trial. Six patients with chronic CME resistant to treatment with systemic steroids, orbital floor steroids, and cyclosporine A. Three patients were followed for more than 1 year, and the other three for between 3 and 9 months. Injection of 2 mg of TA into the vitreous cavity. Optical coherence tomography scanning of the fovea before and after injection and logarithmic minimal angle of resolution visual acuity. Visual acuity, retinal thickness, cystoid space height, and intraocular pressure. There was complete anatomic resolution of CME in five of the six cases within 1 week after injection. Cystoid spaces began to return between 6 weeks and 3 months after injection. Two patients with longer term follow-up responded to further orbital floor steroid injection and had no CME 1 year later. One patient had raised intraocular pressure develop, requiring a trabeculectomy. Mean improvement in visual acuity after 12 months was 0.27 (range, 0.14-0.42). Complete anatomic and, to some extent, functional recovery can be induced by intravitreal TA despite long-term refractory inflammatory CME. Optical coherence tomography aids in the management of these cases.
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            Treatment of retinal detachment resulting from myopic macular hole with internal limiting membrane removal.

            To examine the efficacy of vitrectomy with internal limiting membrane removal for retinal detachment resulting from a macular hole in highly myopic eyes. Eleven consecutive highly myopic eyes (11 patients) with retinal detachment resulting from a macular hole were treated by vitrectomy with removal of the internal limiting membrane, which was stained with indocyanine green and sulfur hexafluoride gas injection. Postoperatively, the patients were instructed to remain prone for 2 weeks. The excised specimens were evaluated with transmission electron microscopy. The mean postoperative follow-up was 9.2 +/- 2.3 months (range, 7 to 13 months). In 10 of the 11 eyes (91%) the retina was reattached during the initial surgery. Redetachment occurred in one eye, which was successfully treated during the second surgery. Best-corrected visual acuity improved in all eyes and ranged from 20/400 to 20/50. Pathologic examination showed that the internal limiting membrane and epiretinal tissues were present in all specimens. The use of indocyanine green staining can facilitate removal of a macular internal limiting membrane and overlying epiretinal membrane, resulting in complete relief of the macular traction. Primary removal of the internal limiting membrane may contribute to a high initial success rate for retinal reattachment and be an important adjuvant to the treatment of retinal detachment resulting from a macular hole in highly myopic eyes.
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              Optical coherence tomographic findings of macular holes and retinal detachment after vitrectomy in highly myopic eyes.

              Macular holes cause retinal detachments in highly myopic eyes. Because degenerative macular changes often coexist, biomicroscopic evaluation of macular hole status after retinal reattachment is sometimes difficult. We studied macular holes with retinal detachment after vitrectomy using optical coherence tomography and evaluated the anatomic status of the hole and factors associated with anatomic success. Retrospective, nonrandomized, comparative study. Sixteen eyes that underwent vitrectomy for retinal detachment associated with a macular hole were included. Internal limiting membrane peeling with indocyanine green was performed in 14 eyes; the epiretinal membrane was peeled with a diamond-dusted membrane scraper alone in two eyes. All retinas reattached postoperatively. The follow-up period at the optical coherence tomography examination was at least 6 months. Optical coherence tomography was performed vertically and horizontally, and the presence of a persistent macular hole was determined. Other information was obtained from patient records. The macular holes closed in seven of 16 eyes (44%). Age, sex, axial length, preoperative best-corrected visual acuity, duration of symptoms, preoperative refractive error, and the preoperative area of the retinal detachment were not significantly correlated with hole closure. Improved postoperative best-corrected visual acuity (P <.05) was significantly associated with macular hole closure, and more frequent visual improvement (P =.06) was of borderline significance. The success rate was lower than those obtained in eyes without myopia or in myopic macular holes without retinal detachments. Macular hole closure may predict improved visual outcome for patients with retinal detachment and macular holes. Optical coherence tomography detects persistent macular holes in highly myopic eyes with retinal detachment.

                Author and article information

                S. Karger AG
                August 2004
                06 July 2004
                : 218
                : 4
                : 248-256
                Department of Ophthalmology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
                78615 Ophthalmologica 2004;218:248–256
                © 2004 S. Karger AG, Basel

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                Page count
                Figures: 6, Tables: 1, References: 23, Pages: 9
                Original Paper


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