title: Influence of intravitreal triamcinolone acetonide injection in scleral buckling surgery for macula-off retinal detachment.
abstract: OBJECTIVE
  To investigate the effect of intravitreal triamcinolone acetonide injection on the resolution of subretinal fluid (SRF), and its correlation with visual outcome after scleral buckle (SB) surgery.
  
  
  METHODS
  A prospective consecutive case series was conducted in patients who underwent SB surgery for macula-off rhegmatogenous retinal detachment (RRD) at Farabi Eye Hospital from February 1, 2012 to August 30, 2013. Exclusion criteria included previous ocular surgery (e.g. primary surgical failure) except cataract surgery, recurrent retinal detachment, macular hole, epiretinal membrane, proliferative vitreoretinopathy grade C, history of trauma, other retinal diseases, and diabetes mellitus. Patients were assigned to two groups. In group 1, patients received 2 mg of intravitreal triamcinolone acetonide injection at the end of surgery while patients in group 2 received intravitreal balanced saline solution for balancing the intraocular pressure (IOP). Patients were followed up at 1 day, 1 week, 1 month, 2 months and 3 months after the surgery by best-corrected visual acuity (BCVA), slitlamp examination, indirect ophthalmoscopy and optical coherence tomography (OCT). OCT (Heidelberg Engineering, Heidelberg, Germany) was used at all visits except day 1 after the surgery. Student's t test and χ(2) tests were used for comparisons; p value ≤ 0.05 was considered significant.
  
  
  RESULTS
  Sixty-two eyes of 62 patients were enrolled in the study. There were 33 male patients (53%) and 29 female patients (47%). The average age was 43.8 years (18-72 years). The mean duration of symptoms was 34.7 ± 46.8 days. There were 29 eyes in group 1 and 33 eyes in group 2. Twelve weeks after the operation, 25 patients (40%) had SRF beneath the macula, but there was no significant difference (p = 0.24, χ(2) test) between the two groups. Improvement in BCVA in both groups was statistically significant (p ≤ 0.001) but did not differ between the two groups (p = 0.09) apart from week 12, in which the improvement in group 1 was significantly higher (p = 0.03). The incidence of cystoid macular edema did not differ in a statistically significant way between the groups (p = 0.19). IOP in 4 (15%) patients in group 1 rose above 21 mm Hg but responded quickly to 2 weeks of topical antiglaucoma medication. There was no cataract progression in either group. There was no correlation between the incidence of persistent SRF and the extent of detachment in both groups (p = 0.83). There was no surgical failure or redetachment in either group during the study period.
  
  
  CONCLUSIONS
  Single-dose intravitreal triamcinolone may increase the final BCVA in macula-off RRD patients despite persistent SRF, suggesting the anti-inflammatory role of this drug.
authors.affiliation: Tehran University of Medical Sciences, Farabi Eye Hospital, Eye Research Center, Tehran, Iran.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Mirshahi
authors.forename: Reza
authors.initials: R
authors.lastname: Karkhaneh
authors.forename: Javad
authors.initials: J
authors.lastname: Zamani Amir
authors.forename: Morteza
authors.initials: M
authors.lastname: Movassat
authors.forename: Pejvak
authors.initials: P
authors.lastname: Azadi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012163:Retinal Detachment / Q000601:surgery*; D012591:Scleral Buckling; D058471:Subretinal Fluid / Q000187:drug effects*; D041623:Tomography, Optical Coherence; D014222:Triamcinolone Acetonide / Q000627:therapeutic use*; D014792:Visual Acuity / Q000187:drug effects*; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D014222:Triamcinolone Acetonide