Residual triamcinolone acetonide at macular hole after vitreous surgery

Abstract

Post traumatic macular holes have shown successful anatomic outcomes with vitrectomy with internal limiting membrane (ILM) peeling and gas injection. Intraocular use of triamcinolone acetonide (TA) crystals is gaining popularity in patients for visualization of the vitreous cortex, posterior vitreous detachment induction and ILM peeling during macular hole surgery. However, the possibility of residual steroid crystals clogging the hole at the conclusion of surgery exists. In our case, residual TA was observed biomicroscopically in the fovea on the seventh day after surgery, Optical Coherence Tomography (OCT) image of the eye showed a hyper reflective mass corresponding to the TA. However, a repeat OCT carried out four weeks after surgery showed recovery of the foveal morphologic features to an almost normal depression, with closure of the hole. Residual TA crystals in the macular hole post vitreous surgery may not interfere with ultimate macular hole closure or visual improvement.

Successful management of persistent macular hole after macular hole surgery with intravitreal triamcinolone acetonide: A case report

“…noted the presence of triamcinolone particles plugging a traumatic MH and inferred that it possibly delayed hole closure. [ 9 ] On the contrary, we believe that TA may have actually aided the hole closure in their case as it did in our case.…”

Comparative evaluation of anatomical and functional outcomes using brilliant blue G versus triamcinolone assisted ILM peeling in macular hole surgery in Indian population

“…However, we did not find any significant difference in hole closure between the two dyes. Other reports have also shown that residual TA in MHS does not seem to interfere with anatomic or visual improvement [49,50].…”

Commentary: Persistent macular hole: A long way to go

“…TA can accumulate at the edges of MH or straddle the hole edges and hence inhibit closure by mechanical blocking the physiological interactions between the sensory retina and the retinal pigment epithelium (RPE). [ 5 ] There are reports asserting the benefits of the macular plug with TA in persistent MH helping in the closure. [ 6 ]…”