J Korean Ophthalmol Soc.  2020 May;61(5):506-513. 10.3341/jkos.2020.61.5.506.

Preservative-free Triamcinolone Acetonide-assisted Visualization of the Internal Limiting Membrane

• Kang KT
• Park UC
• Yu HG

• KMID: 2500723
• DOI: http://doi.org/10.3341/jkos.2020.61.5.506

Abstract

Purpose
To evaluate and compare the degree of visualization of the vitreous and internal limiting membrane (ILM) during pars plana vitrectomy (PPV) using preservative-free triamcinolone acetonide (PF-TA) or triamcinolone acetonide suspension (TAS).
Methods
We retrospectively analyzed the medical records of 61 eyes of 61 patients who underwent 25-gauge PPV and ILM peeling for various macular diseases. We assigned the patients to PF-TA and TAS groups, i.e., according to the type of triamcinolone acetonide used. The degree of visualization of the vitreous and ILM was classified into four different categories. The number of dye injections during PPV, need for indocyanine green (ICG), time elapsed before ILM peeling, and intraocular pressure (IOP) before surgery, 1 day and 1 month after surgery were determined.
Results
The degree of visualization of the vitreous and ILM was significantly better in the PF-TA group compared with the TAS group. Although the number of dye injections during PPV was not different between the PF-TA and TAS groups (2.56 ± 0.07 and 2.37 ± 1.08, respectively, p = 0.06), the need for ICG was significantly different (6 and 22 eyes, respectively, p < 0.01). The time elapsed before ILM peeling was 185.68 ± 130.02 s in the PF-TA group and 411.15 ± 267.38 s in the TAS group (p < 0.01). The IOP was not different before or 1 day after surgery between the PF-TA and TAS groups, but was significantly different 1 month after surgery (12.88 ± 3.10 and 14.41 ± 2.91 mmHg, respectively, p = 0.03).
Conclusions
Visualization of the vitreous and ILM was better when using PF-TA compared to TAS. PF-TA-assisted PPV could reduce the usage of ICG and was associated with a reduced latency to ILM peeling. Because this was in turn associated with a lower IOP at postoperative 1 month, PF-TA was safer and more effective than TAS.

Keyword

Internal limiting membrane; Macula; Pars plana vitrectomy; Triamcinolone