Triamcinolone Acetonide Provides Internal Limiting Membrane Visualization in Macular Hole Repair

Using triamcinolone acetonide (TA) to assist internal limiting membrane (ILM) peel is a safe, effective treatment for macular hole (MH), with results consistent over long-term follow-up, a study published in Clinical Ophthalmology found.

The retrospective chart review of 78 eyes treated at a tertiary care retina practice between 2014-2020 was designed to evaluate long-term anatomic and visual outcomes of MH repair with TA visualization of the ILM, followed by gas tamponade and facedown positioning. Researchers recorded pre- and postoperative visual acuity (VA), intraocular pressure (IOP), and anatomic closure based on optical coherence tomography (OCT). Follow-up was 2.3±0.2 years after primary repair with anatomic closure in 73 (94%) eyes at their final visit, while excluding eyes with pathologic myopia, 97%, and for stage 2 and small MHs, 100%.

Investigators found that in all eyes, VA significantly improved from 0.97±0.04 (Snellen: 20/187) to 0.66±0.06 (20/91) logMAR (P <.0001). A total of 16 eyes had 4 years of follow-up, with 10 eyes (63%) achieving a VA ≥20/30.

Stage 2 and 3 MHs had significantly greater improvements in VA than Stage 4 MHs, −0.46±0.06 vs −0.11±0.11 logMAR (P =.021), they report.

In the 13 (17%) eyes with recurrent MHs, 6 (46%) had pathologic myopia and 8 (61.5%) had associated cystoid macular edema. Fifty-two (96%) phakic eyes had cataract progression, while 2 eyes needed Ahmed valve placement for pre-existing glaucoma management.

Investigators note that when evaluating patients with MH preoperatively, it’s vital to record the stage, size, and duration of the MH for “proper patient education regarding expected outcomes.” Eyes with pre-existing glaucoma may progress postoperatively, possibly attributable to intraoperative steroid exposure or the surgical procedure and gas tamponade, so management is key. And pathologic myopia is a potential problem too, a possible barrier to successful macular hole closure — so “patients may benefit from alternative surgical approaches,” according to investigators.

“Postoperative macular edema is a significant risk for recurrence and should be managed aggressively,” the study concludes.

The study’s main limitations were its retrospective design and lack of a control or comparative arm.

Reference

Wallsh J, Asahi MG, Gallemore R. Long-term outcomes of macular hole repair with triamcinolone acetonide visualization. Clin Ophthalmol. 2021;15:1607-1619. doi:10.2147/OPTH.S303890.