Purpose:

Compare anatomical and functional results of pars plana vitrectomy (PPV) with peeling of the internal limiting membrane (ILM) with and without per-operative intravitreal injection of triamcinolone for the treatment of idiopathic macular epiretinal membrane (IMEM).

Setting:

The intravitreal triamcinolone is used by some surgeons as a co-adjuvant to surgical treatment of idiopathic epiretinal membranes; however, to date little research has been published and there is no general agreement on this topic.

Methods:

Retrospective descriptive-correlational study of 57 cases diagnosed with idiopathic epiretinal membrane and who underwent PPV and peeling of ILM, by the same surgeon between January 2008 and 2013. 37 of the total cases received 2 mg of triamcinolone injection during the surgical procedure and 20 did not receive injection. The best-corrected visual acuity (BCVA) and foveal thickness (FT) were evaluated before surgery and at 2 and 6 months afterwards, and compared between the two groups. Statistical significance was analyzed using SPSS 20 (IBM Corporation, NY).

Results:

This study included 57 eyes of 57 patients (22 were female and 35 were male) with mean age of 72.8 years. Mean BCVA prior to surgery was of 0.44 logarithm of the minimal angle of resolution (logMAR) (Decimal equivalent (DE) 0.36, range <1.0- 0.15 logMAR), with progressive improvement at 2 months postoperatively 0.33 logMAR (0.47 DE, range <1.0 – 0.05 logMAR), and at 6 months 0.27 logMAR (0.53 DE, range <1.0 logMAR); results statistically significant (p < 0.001). Mean BCVA, at 2 and 6 months, among the two groups was not significantly different (p 0.828). The mean foveal thickness decreased from 409.15 µm before surgery to 403.89 µm at 2 months and 384.36 µm at 6 months, the latter reduction being statistically significant. The injected group presented an average thickness (6 months) lower than the group who was not treated with triamcinolone (373.05 µm and 391.14 µm respectively), however the difference was not statistically significant (p 0.501); the d ecrease pattern of the FT over time was different being faster in the injected group. 3 cases required anti-glaucomatous drugs to control intraocular pressure (IOP) but had not been treated with triamcinolone.

Conclusion:

PPV vitrectomy with peeling significantly improves the visual acuity and foveal thickness in patients with IMEM. Additional intravitreal injection of triamcinolone does not significantly improve the visual acuity or the FT, although a faster decrease occurs in the FT of the injected group. There is a theoretical foundation for using triamcinolone but no clear anatomo-functional benefit was found.