Abstract
PurposeTo evaluate the outcome of pneumatic vitreolysis (PVL) for vitreomacular traction (VMT) with or without full thickness macular hole (MH) < 400 µm.MethodsForty-seven eyes of 47 patients were included who had undergone PVL for VMT with or without MH. Main outcome measures were release of VMT, MH closure, best-corrected visual acuity (BCVA) and adverse events.ResultsThirty-three patients had isolated VMT and 14 patients VMT with a MH. Four weeks after PVL, the overall VMT release rate was 35/47 (74.5%): 25/37 (67.6%) in phakic and 10/10 (100%) in pseudophakic eyes (p = 0.03). Four of 14 MH (28.6%) were closed. Twenty-two of 47 (46.8%) eyes required a subsequent PPV: 12/33 (36.4%) in the VMT only group and 10/14 (71.4%) in the VMT with MH group. Mean BCVA improved from 0.48 (± 0.24) to 0.34 (± 0.23) logMAR at 6 months in patients with VMT alone (p < 0.001), and from 0.57 (± 0.27) to 0.41 (± 0.28) logMAR in patients with VMT and MH (p = 0.008). Adverse events included new formation of a large MH in 4/33 (12.1%) eyes, failure of MH closure in 10/14 (71.4%) eyes, progression of mean minimum linear diameter (MLD) MH size from baseline 139 (± 67) to 396 (± 130) µm (p < 0.001) and development of a retinal detachment in 4/47 (8.5%) eyes.ConclusionWhile PVL leads to a high VMT release rate particularly in pseudophakic eyes, it is associated with a relatively high incidence of MH formation, MH size progression and retinal detachment.
Highlights
Vitreomacular traction (VMT) is the result of an abnormal posterior vitreous detachment (PVD) characterised by persistent adherence of the vitreous to the central macula in the presence of partial vitreous separation from the adjacent retina
The aim of this study was to analyse the efficacy and risk profile of pneumatic vitreolysis (PVL) in the treatment of both VMT alone and VMT associated with macular hole (MH), in the absence of any other retinal co-pathology
The use of PVL for the treatment of VMT has been touted as one such potential modality, initially encouraged by high success rates in VMT release and closure of MH ≤ 400 μm. [11,12,13]
Summary
Vitreomacular traction (VMT) is the result of an abnormal posterior vitreous detachment (PVD) characterised by persistent adherence of the vitreous to the central macula in the presence of partial vitreous separation from the adjacent retina. The resultant macular traction may lead to a decrease in central vision and metamorphopsia, potentially culminating in macular hole (MH) formation [1]. Pharmacological treatment in the form of intraocular injection of ocriplasmin has been found to promote liquefaction and separation of the vitreous from the retina due to its proteolytic activity on the vitreoretinal interface [4, 5] and was approved by the Food and Drug Administration in 2012 for VMT with and without MH ≤ 400 μm. There have been reports of retinal breaks with consequent rhegmatogenous retinal detachment (RD). [6,7,8,9,10]
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