Triamcinolone acetonide-assisted internal limiting membrane peeling for macular surgery

Objective To evaluate the effects of triamcinolone acetonide(TA) assisted pars plana vitrectomy for internal limiting membrane(ILM) peeling in the surgery of macular hole and macular epiretinal membrane.Design Retrospective case series.Participants Forty-one eyes of thirty-nine patients with macular holes and twenty-three eyes of twenty-three patients with macular epiretinal membranes were recruited into the study.Methods A standard three-port pars plana vitrectomy was performed in each case.TA was injected into the vitreous cavity to assist surgical posterior vitreous detachment,once the residual vitreous posterior hyaloids was considered to be completely removed from the retina,TA was reinjected toward the posterior retina.After the particles of TA had been deposited on the retinal surface,ILM was peeled off up to 2-3 disc diameters centered on the foveola with intraocular membrane forceps.Main Outcome Measures The visual acuity,optical coherence tomography(OCT) results and complications after vitrectomy.Results The mean follow-up time was(17.73±7.09) months.Visual acuity of sixty-three patients improved,and one has no change at the last follow-up.TA was useful in the removal of the ILM in all cases,which provided a very clear contrast between the flap of peeled ILM and the underlying retina.OCT revealed complete closure in all cases with macular hole.There was no recurrence of epiretinal proliferation in all cases.There was no intraoperative or postoperative complications related with retinal injury.Conclusions Triamcinolone acetonide-assisted peeling of the ILM appears to be safe and effective for macular surgery,and it can reduce the mechanical trauma to the retina.