Triamcinolone Acetonide-Assisted Visualization and Removal of Vitreous Cortex Remnants in Retinal Detachment: A Prospective Cohort Study

Abstract

Background/Objectives: In rhegmatogenous retinal detachment (RRD), vitreous cortex remnants (VCRs) may contribute to the development and progression of proliferative vitreoretinopathy (PVR). This study aimed to evaluate potential toxicity and trauma secondary to VCRs visualization and removal during pars plana vitrectomy (PPV) for RRD. Methods: Prospective study on patients with primary RRD who underwent PPV. Imaging assessment included widefield OCT (WF-OCT), ultra-WF retinography and fundus autofluorescence (FAF). During PPV, a filtered and diluted triamcinolone acetonide (TA) solution (20 mg/mL) was used to evaluate the presence and extension of VCRs, removed using an extendible diamond-dusted sweeper (EDDS). After six months, retinal and retinal pigment epithelium toxicity and retinal trauma due to VCRs removal were investigated. Results: Retinal reattachment was achieved in 21/21 cases included in the study. No signs of retinal or RPE toxicity were detected and WF-OCT performed in the areas of VCRs removal revealed an intact inner retinal architecture in the majority of eyes, with minor and localized inner retinal indentations in 4 cases. Conclusions: VCRs visualization and removal using TA and EDDS appears to be safe, with no retinal toxicity and very limited and circumscribed mechanical trauma. This approach may contribute to reducing the risk of postoperative PVR.

Keywords: proliferative vitreoretinopathy; retinal toxicity; rhegmatogenous retinal detachment; triamcinolone acetonide; vitreous cortex remnants.

Figure 1

Preoperative and postoperative ultrawidefield (UWF) assessment. (A,B): Preoperative UWF retinography of two right eyes presenting a retinal detachment in the temporal quadrants (A) and in the superior and nasal quadrants (B). (A′,B′,A″,B″): postoperative UWF retinography (A′,B′) and autofluorescence (A″,B″). Patient A underwent cataract surgery + vitrectomy + scleral buckle and gas tamponade (C3F8). Patient B underwent vitrectomy with gas tamponade (C3F8). No signs of retinal toxicity were observed in the postoperative UWF assessment.

Figure 2

Postoperative OCT assessment of retinal toxicity. (A): Postoperative ultrawidefield retinography from a patient who underwent pars plana vitrectomy with gas tamponade. The five circles (yellow dotted lines) represent the ≈55° areas observed using wide field OCT to detect outer retina/retinal pigment epithelium (RPE) toxicity following surgery. The white lines represent the position of the B-scan as reported within each circle (lines 1–5). (B): Postoperative ultrawidefield fundus autofluorescence from the same patient. No outer retina/RPE toxicity was observed using the described imaging techniques.

Figure 3

Preoperative and postoperative assessment. Postoperative evaluation of potential retinal trauma. (A,B): preoperative ultrawidefield retinography from a patient affected by primary rhegmatogenous retinal detachment involving the nasal and superior quadrants with a retinal break at XI hours (B1), imaged with a peripheral OCT scan (B2). The patient previously underwent a Kamra inlay implantation to correct presbyopia. The inlay was removed before vitreoretinal surgery. (C,D): postoperative ultrawidefield retinography and autofluorescence. The three dotted yellow circles (C1–C3) represent the ≈55° areas acquired using wide field OCT within the areas of VCRs removal. The white lines represent the position of the B-scan as reported in figures (C1′–C3′, green arrows). In (C3′), the yellow dotted line underlines a small V-shaped inner retinal interruption caused during VCRs removal.