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A prospective randomized clinical study comparing topical nepafenac sodium 0.1% versus intra-operative intravitreal triamcinolone acetate versus placebo in vitrectomy surgery for macular edema

Session Details

Session Title: Vitreo Retinal Surgery I

Session Date/Time: Thursday 11/09/2014 | 08:00-10:00

Paper Time: 08:48

Venue: Auditorium

First Author: : W.C.Lam CANADA

Co Author(s): :    L.D. Zhao   E. Mandelcorn   P. Kertes   R. Devenyi   M. Mandelcorn  

Abstract Details

Purpose:

To compare the relative efficacy of topical Nepafenac 0.1% versus intravitreal triamcinolone (IVTA) versus observation in reducing macular edema post-operatively in patients undergoing vitrectomy for epiretinal membrane, as measured by Optical Coherence Tomography (OCT) imaging and Visual Acuity (VA).

Setting:

This is a prospective, randomized clinical study.

Methods:

80 patients scheduled to undergo vitrectomy surgery for epiretinal membrane were randomized to receive either IVTA (4mg/0.1cc) at end of surgery, topical Nepafenac sodium 0.1% TID for one month post-operation, or no adjuvant treatment following surgery. OCT imaging, best-corrected VA, and intraocular pressure (IOP) were measured pre-operation, at one and two months post-operation. Primary outcome was change in retinal thickness as measured by OCT. Secondary outcomes were change in VA (converted to logMAR) and IOP.

Results:

Control group showed the most improvement of central macular thickness on OCT at both one and two months post-surgery. At two month post-operation, the average macular thickness improved from baseline by -63.89μm (Nepafenac), -106.11 μm (IVTA), and -136.18μm (placebo). There is no overall significant difference in the macular thickness between the three groups at each time point (p= 0.59). The control group had the best improvement in BCVA at two month post-operation as well with +0.207 logMAR; followed by IVTA with +0.106 logMAR and then Nepafenac with +0.084 logMAR. There is no significant difference in BCVA between the three groups overall, p=0.06. Patients' IOP showed fluctuations between preoperative and postoperative with a statistically significant difference in IOP between the three groups (p=0.04).

Conclusions:

Although all three groups showed significant reductions in macular edema post-operatively, the control group showed the most improvement at two month post-operation followed by IVTA and then nepafenac. However, no statistically significance was observed between the three treatment groups. Overall, the data suggests there was no advantage in the use topical Nepafenac or IVTA for post-vitrectomy epiretinal membrane surgery.

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