Visual Outcomes and Safety Profile of “Dropless Vitrectomy” for Epiretinal Membranes

Kakarla V Chalam,1 Anny MS Cheng,2– 4 Suzie Gasparian1 1Department of Ophthalmology, Loma Linda University, Loma Linda, CA, USA; 2Department of Ophthalmology, Broward Health, Fort Lauderdale, FL, USA; 3Department of Ophthalmology, Specialty Retina Center, Deerfield Beach, FL, USA; 4Department of Ophthalmology, University of Florida, Gainesville, FL, USACorrespondence: Kakarla V Chalam, Department of Ophthalmology, Loma Linda University, 11370 Anderson St., Suite 1800, Loma Linda, CA, 92354, USA, Tel +1 904 403-2607, Email [email protected]: 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