title: RECALCITRANT CYSTOID MACULAR EDEMA AFTER PARS PLANA VITRECTOMY.
abstract: OBJECTIVE
  To evaluate the outcomes of different types of treatment of chronic cystoid macular edema (CME) after pars plana vitrectomy.
  
  
  METHODS
  Retrospective review of eyes that developed chronic CME after pars plana vitrectomy treated with intravitreal triamcinolone acetonide (TCA) with or without the addition of anti-vascular endothelial growth factor.
  
  
  RESULTS
  Thirty-nine eyes of 37 patients were included, with a median duration between pars plana vitrectomy and onset of CME of 5 months (interquartile range, 3-12). In most eyes (66.7%), the main indication for surgery was for vitreomacular interface disorders, such as epiretinal membrane, vitreomacular traction, and macular hole. With intravitreal TCA, there was a significant decrease in central foveal thickness at 3, 6, and 12 months, compared with baseline (P = 0.0171, 0.0401, and 0.0024, respectively). A significant gain in vision was noted at 1 month compared with baseline (P = 0.0169), but this was not sustained at 3, 6, and 12 months (P = 0.4862, 0.9098, and 0.4312, respectively). The addition of bevacizumab to TCA did not provide any additional benefit for central foveal thickness and visual acuity. Thirty-two eyes (82.1%) were started on prophylactic antiglaucoma drops 2 weeks after a TCA injection, and no eye needed laser or surgery to control intraocular pressure.
  
  
  CONCLUSIONS
  Chronic CME after pars plana vitrectomy is recurrent and difficult to treat. Intravitreal TCA is effective in reducing CME, but there was only short-term visual acuity improvement even with continued reduction of central foveal thickness. Intraocular pressure did not significantly rise with the use of prophylactic antiglaucoma drops even with repeated injections.
authors.affiliation: Jacobs Retina Center, University of California San Diego Shiley Eye Institute, La Jolla, California.
authors.forename: Mostafa R
authors.initials: MR
authors.lastname: Alam
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Arcinue
authors.forename: Nadia B
authors.initials: NB
authors.lastname: Mendoza
authors.forename: William R
authors.initials: WR
authors.lastname: Freeman
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000068258:Bevacizumab / Q000627:therapeutic use; D002908:Chronic Disease; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D058449:Intravitreal Injections; D008269:Macular Edema / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D011183:Postoperative Complications; D012008:Recurrence; D012164:Retinal Diseases / Q000601:surgery; D041623:Tomography, Optical Coherence; D014222:Triamcinolone Acetonide / Q000627:therapeutic use; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity; D014821:Vitrectomy / Q000009:adverse effects*
chemical_list: D020533:Angiogenesis Inhibitors; D005938:Glucocorticoids; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D014222:Triamcinolone Acetonide