Visual Outcomes and Safety Profile of "Dropless Vitrectomy" for Epiretinal Membranes

Abstract

Purpose: To assess the clinical effectiveness and safety of Tri-Moxi intravitreal injection in comparison to standard postoperative topical steroid-antibiotic treatment after epiretinal membrane (ERM) removal with pars plana vitrectomy (PPV).

Methods: A retrospective longitudinal cohort study of 278 eyes undergoing ERM removal by PPV was conducted from 2019 to 2023. Group 1 (N = 139) received a triamcinolone acetonide-moxifloxacin (Tri-Moxi) intravitreal injection at the conclusion of surgery, and Group 2 (N = 139) had postoperative standard topical antibiotic-steroid therapy. Clinical changes of best-corrected visual acuity (BCVA), intraocular pressure (IOP), and central foveal thickness (CFT) were evaluated.

Results: By 3-month after surgery, the Tri-Moxi (Group 1) demonstrated a significantly greater reduction in CFT (178 ± 32 vs 145 ± 38 µm, P < 0.001) and a slightly superior improvement in BCVA (0.34 ± 0.03 vs 0.41 ± 0.04 logMAR, P < 0.05) compared to the standard (Group 2). Postoperative IOP remained minimal change in both groups. The occurrence of cystoid macular edema was markedly reduced in patients receiving Tri-Moxi (4% vs 10%, P = 0.02). No infection or ocular hypertension cases were recorded.

Conclusion: For the postoperative management of PPV in ERM patients, intravitreal Tri-Moxi injection is an efficacious and safe alternative to standard topical therapy. Intravitreal Tri-Moxi can be used as a viable treatment option for managing inflammation and preventing infection after epiretinal membrane removal by pars plana vitrectomy. Tri-Moxi group demonstrated superior anatomical outcomes and comparable functional outcomes while simplifying postoperative care and reducing the occurrence of cystoid macular edema compared to standard topical therapy.

Keywords: central macular edema; drop less; epiretinal membrane; inflammation; moxifloxacin; triamcinolone acetonide; vitrectomy surgery; wound healing.

Figure 1

Pars plana intravitreal injection of Tri-Moxi 4.0 mm posterior to the limbus in inferotemporal quadrant of the right eye after removal of epiretinal membrane. Medication was injected using a 30-gauge needle (4 mm length) on a tuberculin syringe.

Figure 2

Reduction of central foveal thickness (CFT) of the macula measured by optical coherence tomography (OCT) after pars plana vitrectomy (PPV). The epiretinal membrane before PPV (A) was completely removed and intraoperative intravitreal Tri-Moxi was effective to resolve CFT (B). The vertical green line quantified the corresponding foveal thickness before and after treatment (474 vs 265 µm) by measuring the distance between the internal limiting membrane and the outer Bruch’s membrane.

Figure 3

By 3-month after surgery, the Tri-Moxi demonstrated a significantly greater reduction in (A) central foveal thickness (CFT) (P < 0.001) and a slightly superior improvement in improvement of (B) best-corrected visual acuity (BCVA) (P < 0.05) compared to the standard therapy. (C) Postoperative IOP remained minimal change in both groups. The occurrence of (D) cystoid macular edema (CME) was markedly reduced in patients receiving Tri-Moxi (P = 0.02).