Prospective study comparing the effectiveness of scleral buckling to vitreous surgery for rhegmatogenous retinal detachment.

PURPOSE: To compare the effectiveness of scleral buckling to vitrectomy for the treatment of rhegmatogenous retinal detachment (RRD) due to equatorial retinal tears. METHODS: Forty-six patients (46 eyes) > or =50 years of age with RRD due to equatorial retinal tears were studied. One group of 23 patients was selected by the randomized envelope method to be treated by scleral buckling and a second group of 23 to be treated by vitrectomy. The rate of retinal reattachment, the visual acuity, optical coherence tomography findings, and postoperative complications were determined. In addition, a questionnaire was filled out by the patients on their subjective assessment of the surgery and recovery. RESULTS: The rate of retinal reattachment was identical in the two groups. The postoperative visual acuity, the number of patients with visual acuity > or =0.8 and the mean visual acuity were significantly better in the vitrectomy group (chi-squared and Mann-Whitney U tests, P < 0.05) within 12 months after surgery. At 24 and 36 months, the differences in the visual acuity were not significant. The answers to the questionnaire given by the patients in the vitrectomy group suggested that their surgical experiences and visual recovery were better than those of patients in the scleral buckling group. CONCLUSION: In patients > or =50 years of age, vitrectomy was more effective than scleral buckling for obtaining good visual acuity in the short term.

Trans-Tenon's retrobulbar injection of triamcinolone acetonide for diffuse diabetic macular edema.

PURPOSE: To determine whether a trans-Tenon's retrobulbar injection of triamcinolone acetonide (TA) is a safe and effective treatment for diffuse diabetic macular edema. METHODS: Thirty-nine eyes of 30 diabetic patients with persistent macular edema were treated with 20 mg of TA injection. Central macular thickness (CMT) determined by optical coherence tomography (OCT) and visual acuity were evaluated before the injection and at 1, 2, 3, and 6 months, and up to 1 year in some eyes, after the injection. RESULTS: The CMT decreased significantly from 478 +/- 129 microm (mean +/- SD) before injection to 316 +/- 102 microm at 1 month, 307 +/- 104 microm at 2 months, and 275 +/- 89 microm at 3 months after a single injection of TA. A 20% reduction of CMT from the initial value was maintained by a single injection of TA in 27 of 39 eyes (69.2%) at 3 months, in 14 of 22 eyes (63.6%) at 6 months, and in 5 of 7 eyes at 12 months. A recurrence of macular edema was observed in 10% of the eyes at 3 months, and in 22.7% at 6 months. The 17 eyes in which vitrectomy had been carried out had a more significant improvement in CMT than the eyes without vitrectomy. CONCLUSION: A 20-mg trans-Tenon's retrobulbar TA injection is a safe and effective treatment for diabetic macular edema.