title: Pars plana vitrectomy combined with internal limiting membrane peeling for recurrent macular edema due to branch retinal vein occlusion after antivascular endothelial growth factor treatments.
abstract: OBJECTIVE
  To evaluate the anatomic and functional outcomes of pars plana vitrectomy combined with internal limiting membrane peeling for recurrent macular edema (ME) due to branch retinal vein occlusion (BRVO) after intravitreal injections of antivascular endothelial growth factor (anti-VEGF) agents.
  
  
  METHODS
  Twenty-four eyes of 24 patients with treatment-naive ME from BRVO were treated with intravitreal injections of anti-VEGF agents. Recurred ME was treated with pars plana vitrectomy combined with internal limiting membrane peeling.
  
  
  RESULTS
  After the surgery, ME was significantly reduced at 1 month (P=0.031) and the reduction increased with time (P=0.007 at the final visit). With the reduction in ME, treated eyes showed a slow improvement in visual acuity (VA). At the final visit, improvement in VA was statistically significant compared with baseline (P=0.048). The initial presence of cystoid spaces, serous retinal detachment, or subretinal hemorrhage under the fovea, as well as retinal perfusion status, showed no association with VA improvement. However, the presence of epiretinal membrane showed a significant association with the visual recovery. Although eyes without epiretinal membrane showed visual improvement (-0.10±0.32 in logarithm of the minimum angle of resolution [logMAR]), eyes with epiretinal membrane showed greater visual improvement (-0.38±0.12 in logMAR, P=0.012).
  
  
  CONCLUSIONS
  For recurrent ME due to BRVO after anti-VEGF treatment, particularly when accompanied by epiretinal membrane, pars plana vitrectomy combined with internal limiting membrane peeling might be a possible treatment option.
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Kagawa University, Miki-cho, Japan.
authors.forename: Yukari
authors.initials: Y
authors.lastname: Shirakata
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Kagawa University, Miki-cho, Japan.
authors.forename: Kouki
authors.initials: K
authors.lastname: Fukuda
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Kagawa University, Miki-cho, Japan.
authors.forename: Tomoyoshi
authors.initials: T
authors.lastname: Fujita
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Kagawa University, Miki-cho, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Nakano
authors.affiliation: Nomoto Eye Clinic, Himeji, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nomoto
authors.affiliation: Department of Ophthalmology, Shirai Eye Hospital, Mitoyo, Japan.
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Yamaji
authors.affiliation: Department of Ophthalmology, Okayama University, Okayama, Japan.
authors.forename: Fumio
authors.initials: F
authors.lastname: Shiraga
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Kagawa University, Miki-cho, Japan.
authors.forename: Akitaka
authors.initials: A
authors.lastname: Tsujikawa
keywords: antivascular endothelial growth factor; branch retinal vein occlusion; internal limiting membrane peeling; macular edema; pars plana vitrectomy