Residual Intraretinal Edema After 25-Gauge Vitrectomy and Macular Pucker Removal

Abstract

Intraoperative sustained-release dexamethasone implant, a powerful antiinflammatory agent with significant efficacy in vitrectomized eyes, did not result in a significant change in macular thickness and volume compared with the vitrectomy alone without dexamethasone implant at 6-month follow-up. These data support the hypothesis that its etiology does not seem to be mainly related to an inflammatory process.

Comparative study of pars plana vitrectomy with or without intravitreal dexamethasone implant for idiopathic epiretinal membrane

“…A randomized, controlled trial by Guidi et al . [ 9 ] tested the effectiveness of intraoperative slow-release dexamethasone implants in improving BCVA after 25-G vitrectomy and ERM removal in patients affected by idiopathic macular pucker. After 6 months, the study indicated that although there were significant improvements in BCVA scores, and reductions in foveal thickness post-surgery, there were no significant differences between the control group and the group receiving the dexamethasone implants.…”

“…After 6 months, the study indicated that although there were significant improvements in BCVA scores, and reductions in foveal thickness post-surgery, there were no significant differences between the control group and the group receiving the dexamethasone implants. [ 9 ] However, Guidi et al . [ 9 ] did not investigate early-stage improvements in BCVA scores or reduction in foveal thickness in their patients.…”

“…[ 3 4 ] However, improvement in VA and macular thickness are often slow with only 70% of operated patients experiencing a significant improvement in vision in the operated eye over 6 months to 1 year. [ 5 6 7 ] Various studies have reported the differing efficacies of concomitant use of steroids—intravitreal triamcinolone acetonide (IVTA) and dexamethasone—to control chronic inflammation in the hope of improving VA.[ 8 9 10 11 ] While most of these studies have reported improvements in VA and CRT at 6 months post-surgery, none have investigated the early effects (1-month post-surgery) of steroid therapy.…”

Treatment of Macular Edema after Pars Plana Vitrectomy for Idiopathic Epiretinal Membrane Using Intravitreal Dexamethasone Implant: Long-Term Outcomes

“…In fact, the first trigger in the development of macular edema in ERM patients seems to be more mechanical due to tractional forces of ERM on the retina. However, this mechanical distortion of the retinal surface may lead to secondary biochemical pathways, including the release of various cytokines or growth factors [23, 24]. In addition, inflammation has been proven to be induced by PPV per se in patients who undergo PPV for various etiologies [25].…”

“…The existing studies have demonstrated that the administration of intravitreal triamcinolone in patients treated with PPV for ERM removal leads to a significant decrease in CRT but does not significantly influence the visual outcomes in the majority of studies [13-15]. Noticeably, triamcinolone has been found to last approximately 113 days in vitrectomized eyes [15], while intravitreal dexamethasone implant has been shown to be 6 times more effective than triamcinolone [24]. However, Yonekawa et al [26] reported a similar trend between triamcinolone and intravitreal dexamethasone implant regarding anatomical and functional outcomes in patients affected by macular pucker and treated with PPV, although this was a retrospective study without a control group.…”