[Surgical treatment of persistent macular edema in retinal vein occlusion].
BACKGROUND
Persistent macular edema (ME) is the main cause of poor visual outcome in nonischemic retinal vein occlusion (RVO). The aim of this study was to evaluate the results of surgery in this disorder.


METHODS
Retrospective nonrandomized comparative pilot study. Visual acuity measurement, fluorescein angiography, and optical coherence tomography were performed before and after treatment, at 3 months, 6 months, and 1 year.


RESULTS
The study included 42 eyes: 15 eyes underwent vitrectomy with peeling of the posterior hyaloid and/or the internal limiting membrane, 19 received intravitreous injection of triamcinolone (IVT), and four had a combination of both treatments. In the vitrectomy group, 63% of the eyes showed a progressive decrease of ME throughout the year of follow-up (p<0.05 at 1 month and 1 year) and an increase in visual acuity (p<0.05 at 3 and 6 months); no complication occurred. In the IVT group, the eyes showed a rapid improvement in vision and in ME at 1 month (p=0.007 and p=0.001, respectively) but with a frequent ME recurrence at 4 months; however, 31% of eyes showed durable improvement. Complications after IVT were pseudo-endophthalmitis (one eye), transient hypertony (53%), and a full-thickness macular hole (one eye). In the group treated with vitrectomy combined with IVT, ME decreased rapidly and durably, but vision did not improve in this small subgroup of long-lasting RVO with prior pigment epithelial changes.


CONCLUSIONS
In some eyes, vitrectomy seems to have a more durable effect than IVT alone. Further randomized and controlled studies are needed to confirm these results and to compare them to the natural course of the disease.
Nkeme
J
J
Service d'Ophtalmologie, Centre Hospitalier Intercommunal et Hôpital Henri Mondor (AP-HP), Créteil.
Glacet-Bernard
A
A
Gnikpingo
K
K
Zourdani
A
A
Mimoun
G
G
Mahiddine
H
H
Gkoritsa
A
A
Tchamo
A
A
Coscas
G
G
Soubrane
G
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008269:Macular Edema / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012170:Retinal Vein Occlusion / Q000150:complications*; D012189:Retrospective Studies