Safety of Triamcinolone acetonide (TA)-assisted pars plana vitrectomy in macular hole surgery

Abstract

Aim To evaluate whether Triamcinolone acetonide (TA)-assisted pars plana vitrectomy for visualisation of posterior hyaloid during macular hole surgery has any adverse effects on macular hole closure rate and intraocular pressure (IOP). Methods Case series comparing outcomes and adverse effects in patients who had surgery for macular holes with ILM peel, with and without the use of TA-assisted vitrectomy. Results During the study period, 29 patients had vitrectomy for macular holes. In 18 patients (group 1), TA was used intraoperatively to facilitate visualisation of the posterior hyaloid and in 11 patients (group 2) no TA was used. There was no statistically significant difference in the macular hole closure rates and the improvement in visual acuity between the two groups. No long-term increase in IOP was recorded in any of the 29 patients. The total anatomical success rate in both groups was 85.6% and the average improvement in visual acuity in both groups was two Snellen lines. Conclusions TA is safe and there is no contraindication for its use as an intraoperative aid to facilitate vitreous visualisation in macular hole surgery.

State of the art in chromovitrectomy

“…Subsequent pathology disclosed the presence of ILM in specimens after TA-assisted peeling, thereby showing that is possible to remove ILM and not just vitreous. (2,8) Since then other studies have confirmed that TA-assisted ILM removal gives good results (figure 7D) (39)(40)(41) . Compared to ICG-guided ILM removal, a noncontrolled study indicates that TA has the same closure rate with significantly better visual results with no side effects (42) .…”

“…A recent study compared ILM peeling with and without the use of TA. During a mean follow-up of 7.3 months, no recurrence of the MH was observed (40) . Despite of this concern, preservative-free TA appears to be a preferred agent in chromovitrectomy (43) .…”

Use of triamcinolone during vitrectomy surgery to visualize membranes and vitreous

“…As shown with previous studies of intravitreal triamcinolone, the more common complications include cataract formation and elevated intraocular pressure. However, the incidence of these complications are less than expected Sakamoto et al 2002;Chang et al 2006;Kampougeris et al 2007;Kumagai et al 2007;Ueno et al 2007;Hikichi et al 2008). Several studies have shown residual retinal TA after PPV.…”

“…It is well known for its anti-angiogenic and anti-fi brotic properties, which can have a benefi cial effect in the treatment of conditions commonly treated with intraocular surgery (Kampougeris et al 2007). One study objectively showed a decrease in postoperative blood-ocular barrier breakdown after TA-assisted PPV, especially for diabetic macular edema (Sakamoto et al 2002).…”

“…Since TA simply integrates into the collagen matrix it can be removed with continuous aspiration or irrigation. However, unlike ICG or TB, TA can be repeated until desired visualization is achieved (Shah et al 2004;Horio et al 2005;Rodrigues et al 2005;Kampougeris et al 2007).…”