Intravitreal injection of crystalline cortisone as adjunctive treatment of proliferative vitreoretinopathy

Abstract

AIM To report on clinical outcome and complications of intravitreal injection of crystalline cortisone in patients undergoing pars plana vitrectomy for treatment of proliferative vitreoretinopathy.

METHODS The study included all 16 patients who underwent pars plana vitrectomy for treatment of proliferative vitreoretinopathy, who received an intravitreal injection of 10–20 mg crystalline triamcinolone acetonide at the end of surgery, and who were operated on by the same surgeon. Most of the vehicle of the solution containing the cortisone crystals was removed before performing the injection. Mean follow up time was 1.64 (SD 2.15) months (median 1.23 months; range 0.20–9.20 months). The study group was compared with a control group which consisted of 144 patients undergoing pars plana vitrectomy for proliferative vitreoretinopathy performed by the same surgeon.

RESULTS In the study group compared with the control group, intraocular inflammation, as estimated clinically by slit lamp biomicroscopy, was lower, appearance of the fundus upon ophthalmoscopy in the first postoperative week was clearer, and postoperative pain in the first two postoperative days was reduced. Intraocular pressure measured at the end of the first postoperative week did not vary significantly between the groups. A pseudohypopyon consisting of cortisone crystals in the inferior anterior chamber angle was detected in one patient. Postoperative infectious endophthalmitis was not encountered.

CONCLUSIONS This pilot study suggests that intravitreal injection of crystalline cortisone with most of the vehicle removed is not toxic to intraocular structures, reduces postoperative intraocular inflammation, and may be a potentially useful additional tool in the treatment of proliferative vitreoretinopathy.