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In this study the authors evaluated the efficacy of vitrectomy combined with corticosteroid injection for idiopathic epiretinal membrane (ERM). A systematic literature review was conducted by searching three electronic databases, PubMed, Embase and Medline, up to 2020 for relevant studies. In the studies included for meta-analysis, doses of intravitreal slow-release dexamethasone and intravitreal triamcinolone were 0.7 mg and 4 mg, respectively. Eight studies met the criteria and provided data on a total sample of 443 eyes. The data was pooled and meta-analysis was performed. In terms of central macular thickness (CMT) reduction at one, three and six months after operation the meta-analysis showed that combined treatment with vitrectomy and intravitreal corticosteroid for ERM removal contributed to significant CMT reduction three months after operation than vitrectomy alone (pooled SMD=−0.353; 95% CI: −0.594 to −0.111; p=0.004). The results showed no significant benefit from the combination of vitrectomy and intravitreal corticosteroid therapy for ERM removal at one and six months after operation. Regarding best corrected visual acuity (BCVA) the results showed that both combined treatments with intravitreal slow-release dexamethasone implant and vitrectomy, or intravitreal triamcinolone injection and vitrectomy had no significant improvement in BCVA compared with vitrectomy alone at one, three, and six months after operation. Overall, the pooled results showed that combining vitrectomy with intraocular corticosteroid injection results in a higher rate of increased IOP that required anti-glaucoma medications (pooled risk ratio=3.54; 95% CI: 1.36–9.21; p=0.01). All patients suffering from elevated IOP after the operation in the included study were successfully treated with topical anti-glaucoma drops. Limitations of this meta-analysis include its retrospective nature and small sample size, due to inclusion of limited number of studies. The study does not mention the effect of tamponade on anatomical and functional outcome after ERM surgery and the surgeon and technique bias have not been considered.

Efficacy of combined vitrectomy with intravitreal corticosteroid injection for idiopathic epiretinal membrane removal on anatomical and functional outcomes: a meta-analysis.
Chen HJ, Hsiao CH, Chang CJ.
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Sofia Rokerya

MBBS MRCOphth FRCSI, King's College University Hospital, UK.

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