Symptomatic Vitreomacular Traction Research Articles

Pneumatic Vitreolysis using C3F8 Gas in Treatment Naive Patients with Vitreomacular Traction.

Evaluation of the effectiveness of pneumatic vitreolysis in disrupting vitreomacular traction in our own cohort of patients. Prospective follow-up of 21 eyes of 18 patients with focal VMT (adhesion width < 1500 µm) who underwent intravitreal injection of 0.3 ml of 100% perfluoropropane between January 2015 and December 2020. The patients were observed for 90 days. Release of VMT was achieved on the 28th day of observation in 15 out of 21 eyes (71.4%), and by the 90th day in 19 out of 21 eyes (90.5%). The average width of adhesion in our patients was 382 µm (±212 µm). Average best corrected visual acuity in our cohort was initially 0.77 (±0.21), after 28 days 0.74 (±0.30), and after 3 months 0.82 (±0.21). At the end of the follow-up period, we did not observe a statistically significant improvement in vision. Macular holes developed in two eyes, but spontaneously closed within 1 month of observation, and no more complications were observed in the cohort. Pneumatic vitreolysis by intravitreal injection of C3F8 gas is an effective and inexpensive option for the management of symptomatic vitreomacular traction. The incidence of serious adverse events in our follow-up was significantly lower than in recently published series. The method of management should be selected individually according to the parameters of adhesion, macular hole and associated ocular pathologies.

Evaluating the effect of Perfluoropropane assisted pneumatic vitreolysis in cases of symptomatic focal vitreomacular traction

Purpose The aim of this study was to evaluate the effect of pneumatic vitreolysis (PVL) in the management of symptomatic focal vitreomacular traction (VMT). Patients and methods This prospective non-comparative interventional study was conducted on 21 eyes of 20 patients with isolated focal VMT detected by optical coherence tomography (OCT). All patients were symptomatic complaining of decreased vision and/or metamorphopsia with persistence of VMT for at least 3 months before intervention. All patients received a single intravitreal injection of 0.3 ml pure perfluoropropane (C3F8) and were followed up for 6 months post-injection. During the follow up period, the patients were evaluated regarding the occurrence of release of VMT as detected by OCT, the change in best corrected visual acuity (BCVA), and the change in central macular thickness (CMT) by OCT. Results The single intravitreal gas injection of C3F8 resulted in the release of VMT in 16 (76.2%) eyes. The mean BCVA significantly improved from 0.71±0.16 LogMAR (range: 1–0.5) at baseline to 0.38±0.22 LogMAR (range: 1.0–0.2) by the final visit at 6 months postoperatively (P<0.001). In addition, the mean CMT significantly decreased from 461.67±68.60 µm (range: 318–573 µm) at baseline to 331.55±90.27 µm (range: 278–568 µm) at 6 months postoperatively (P<0.001). One patient developed a retinal break and was treated by retinopexy, and one patient developed a full-thickness macular hole that was treated by vitrectomy. Conclusions PVL was found to be an effective method for treatment of symptomatic VMT.

Efficacy and safety of pneumatic vitreolysis for management of vitreomacular traction syndrome

AbstractPurpose: To evaluate the outcome of small volume injection of perfluoropropane (C3F8) gas for symptomatic vitreomacular traction (VMT).Methods: A retrospective review of eyes with VMT treated with a limited volume of 0.2 ml of C3F8 gas was performed with limited face‐down position. Main outcome measures were release of VMT, best‐corrected visual acuity (BCVA), central macular thickness (CMT) and adverse events.Results: Ten consecutive patients with symptomatic VMT underwent pneumatic vitreolysis. Overall success was of 90% in VMT release. The CMT decreased from 397,8 μm ±) 81.87) preoperatively to 309,8 μm ±) 51.76) postoperatively (p < 0.001). Mean BCVA improved from 0.42 ±) 0.24) to 0.24±) 0.23) logMAR at 6 months (p < 0.001). One patient with a large VMT had no change in the optical coherence tomography aspect. Another patient with large VMT associated to large retrofoveal cyst has VMT release but formed a macular hole after gas injection. No other adverse events were seen.Conclusions: Pneumatic vitreolysis with small volume of C3F8 and limited face‐down position is a viable option for treating VMT with few adverse events. Macular hole formation can occur in cases of large retrofoveal cysts.

Calculating the individual probability of successful ocriplasmin treatment in eyes with vitreomacular traction-Validation and refinement of a multivariable prediction model.

PurposeTo evaluate a multivariable model predicting the individual probability of successful intravitreal ocriplasmin (IVO) treatment in eyes with vitreomacular traction (VMT).MethodsData from three prospective, multicenter IVO studies (OASIS, ORBIT, and INJECT) were pooled. Patients were included if they were treated for a symptomatic VMT without a full-thickness macular hole. A prediction model for VMT resolution using the factors ‘age’ and ‘horizontal VMT diameter’ was validated by receiver operating characteristic analysis and according to grouped prediction after calibration. Multivariable regression analysis was performed to check robustness and explore further improvements.ResultsData from 591 eyes was included. In the univariate analysis all key factors (age, gender, VMT diameter, lens status, ERM) significantly correlated to treatment success. The prediction model was robust and clinically applicable to estimate the success rate of IVO treatment (AUC of ROC: 0.70). A refinement of the model was achieved through a calibration process.ConclusionThe developed multivariable model using ‘horizontal VMT diameter’ and ‘age’ is a valid tool for prediction of VMT resolution upon IVO treatment.

PNEUMATIC VITREOLYSIS VERSUS PARS PLANA VITRECTOMY IN FOCAL SYMPTOMATIC VITREOMACULAR TRACTION SYNDROME

To compare pneumatic vitreolysis and pars plana vitrectomy in the management of focal symptomatic vitreomacular traction (VMT). Patients aged 18 years or older, with idiopathic focal symptomatic VMT and best-corrected visual acuity <20/40, without any other retinal pathology were randomized to undergo pneumatic vitreolysis (Group 1) or pars plana vitrectomy (Group 2). The primary outcome measure was resolution of traction confirmed with optical coherence tomography at 3 months. Secondary outcome measures were to compare changes in best-corrected visual acuity, central foveal thickness, and complications if any. A total of 30 eyes of 30 patients were included with 15 eyes in each group. Vitreomacular traction resolved successfully in 12 of 15 (80%) eyes in Group 1 and in all (100%) eyes in Group 2 (P = 0.224). The mean visual acuity improved from 0.80 ± 0.26 (20/126 Snellen's equivalent) to 0.70 ± 0.46 logMAR (20/100 Snellen's equivalent) in Group 1 (P = 0.71) and from 0.904 ± 0.44 (20/160 Snellen's equivalent) to 0.47 ± 0.26 logMAR (20/59 Snellen's equivalent) in Group 2 (P = 0.0016). Although 4 of 15 (26.66%) eyes in Group 1 had formation of full-thickness macular hole and 7 eyes required resurgery (4 for full-thickness macular hole and 3 for unresolved VMT), none in the pars plana vitrectomy group had any complications requiring resurgery (P = 0.0063). Two eyes in the pars plana vitrectomy group had intraoperative deroofing of the fovea leading to full-thickness macular hole. Pars plana vitrectomy is better than pneumatic vitreolysis as a single intervention in the management of focal symptomatic VMT.

Effect of pneumatic vitreolysis in management of patients with symptomatic focal vitreomacular traction

PurposeTo evaluate the efficacy of single intravitreal injection of an expansile concentration of sulphur hexafluoride gas (SF6) in treating patients with symptomatic focal vitreomacular traction (VMT) documented by spectral domain optical coherence tomography (SD-OCT) preoperatively. MethodsThis is a prospective interventional case series including 30 eyes of 29 patients with symptomatic focal VMT evident on SD-OCT. Pre-operatively, mean best corrected visual acuity (BCVA) was 20/125 (range 20/400–20/40). Mean central foveal thickness (CFT) was 382 μm (range 149–576 μm; SD ± 91.88). All eyes received single intravitreal injection of 0.3 mL of 100% SF6 gas. Postoperatively, we performed SD-OCT at one week, one month, and three months for all eyes. Primary outcome measure was release of VMT. Secondary outcome measures were changes in postoperative BCVA andCFT. ResultsOverall, VMT release occurred in 24 of 30 eyes by the final follow-up visit (80% final release rate); furthermore, 76.9% of eyes with diabetic maculopathy and 25% of eyes with concurrent epiretinal membrane (ERM) had successful VMT release. VMT release was documented on SD-OCT at an average of 3 weeks (range, 1–12 weeks). The rate of release in phakic eyes was 90% (18 of 20 eyes) versus 60% in pseudophakic eyes (6 of 10 eyes). One patient developed a retinal break at upper nasal retina after two weeks of injection.ConclusionPneumatic vitreolysis (PVL) with limited face-down position is a viable option for treating focal VMT with few adverse events. Further studies are needed to evaluate its indications, benefits, and risks.

Evaluation of the efficacy of pneumatic vitreolysis treatment for symptomatic vitreomacular traction syndrome

Evaluation of the efficacy of pneumatic vitreolysis treatment for symptomatic vitreomacular traction syndrome

Vitreomacular Traction Surgery from the DISCOVER Study: Intraoperative OCT Utility, Ellipsoid Zone Dynamics, and Outcomes.

To characterize the clinical and ellipsoid zone (EZ) integrity outcomes in surgical intervention for symptomatic vitreomacular traction (VMT), and to evaluate the utility of intraoperative optical coherence tomography (OCT) during VMT surgery. This was a post-hoc analysis of eyes in the DISCOVER study undergoing pars plana vitrectomy (PPV) with intraoperative OCT for VMT-related macular disease. Data were collected prospectively on feasibility and utility of intraoperative OCT, with follow-up lasting 12 months. Forty-three eyes of 41 patients were included and mean visual acuity improved from 20/96 to 20/45 (P < .001). Intraoperative OCT provided information that impacted surgical decision-making in eight patients (18.6%). EZ integrity metrics significantly improved from baseline to 12 months and directly correlated with functional outcomes (P < .001). Retinal function and morphology improved significantly following PPV for VMT. Intraoperative OCT provided surgeon-perceived valuable information in select cases. Further research is needed to determine whether this information impacts overall surgical outcomes. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:544-550.].

Indications and outcomes for intravitreal injection of C3F8 gas for symptomatic vitreomacular traction

To evaluate the indications and outcomes of perfluoropropane (C3F8) gas injection for symptomatic vitreomacular traction (VMT). A retrospective analysis of eyes with VMT treated with 0.3 mL of C3F8 gas was performed. Patients were not asked to posture after gas injection. In phakic patients, cataract surgery was performed simultaneously. Patients were examined after one week and one month postoperatively. Twenty-nine consecutive eyes of 26 patients with symptomatic VMT who underwent pneumatic vitreolysis were included. A complete posterior vitreous detachment was achieved in 18 eyes (62.1%) after a single gas injection at the final visit. The rate of posterior vitreous detachment was reduced significantly with the presence of epiretinal membrane (ERM) (p = 0.003). Three eyes formed a macular hole (MH) postoperatively and another eye developed a retinal detachment. Mean visual acuity increased significantly after one month (p < 0.008). Pneumatic vitreolysis is a viable option for treating VMT with few adverse events. Patient with concomitant ERM had a significantly lower success rate.

UNILATERAL TRANSIENT VISION LOSS FOLLOWING BILATERAL INTRAVITREAL OCRIPLASMIN – CASE REPORT WITH TWO YEARS FOLLOW UP

Abstract Background: Ocriplasmin is a serine protease approved for the treatment of symptomatic vitreomacular traction (VMT). Post-marketing experience has revealed safety concerns. Materials and Methods: Retrospective case report. Clinical and surgical data were analyzed. Results: We report a case of intraindividual response to bilateral ocriplasmin injection in a 70 year-old female patient with symptomatic vitreomacular traction syndrome. A single surgeon injected the same patient twice, two years appart, following the same protocol. In the first eye we observed the commonest side effects and no VMT release while in the second eye we documented the rarer and severe ocriplasmin’s adverse events nevertheless with successful VMT release. Conclusions: Ocriplasmin’s severe adverse events are unpredictable and underreported. The noticeable difference in adverse events is not accounted by patient, surgeon or tecnique’s variability. This case raises the question of whether the degree of enzymatic cleavage necessary for drug efficacy and VMT release may coexist with more retinal toxicity.

Intravitreal tissue plasminogen activator for treatment of vitreomacular adhesion

AIM: To evaluate the role of a single intravitreal injection of tissue plasminogen activator alone (TPA) for treatment of vitreomacular traction and the effect of combined intravitreal TPA and bevacizumab on retinal vascular diseases. METHODS: In this prospective, interventional case series a total of 24 eyes from 24 patients were studied. There were 5 eyes with symptomatic vitreomacular traction syndrome (VMT) and 19 eyes with retinal vascular diseases including diabetic macular edema (DME), diabetic vitreous hemorrhage (VH), central retinal vein occlusion (CRVO) and neovascular age related macular degeneration (AMD). Measurement of visual acuity, B-scan and OCT were performed at the baseline and 1mo after injections. Three eyes with VMT received a single intravitreal injection of 50 μg and two eyes received 100 μg TPA. Totally 19 eyes with retinal vascular diseases received combined intravitreal TPA (50 μg) and Bevacizumab (1.25 mg). RESULTS: The mean ages for retinal vascular diseases and VMT patients were 56.8y and 60.4y, respectively. Ten patients (41.7%) were male and 14 patients (58.3%) were female. 22 eyes (91.7%) were phakic and 2 eyes (8.3%) were pseudophakic. The incidence of posterior vitreous detachment (PVD) was 0% (0 of 5) and 57.8% (11 of 19) for VMT and retinal vascular diseases, respectively (P=0.04). Improvement of best corrected visual acuity (BCVA) and decrement of central macular thickness (CMT) were significantly greater in PVD positive eyes compared with PVD negative eyes. CONCLUSION: Intravitreal injection of TPA was not successful to induce complete PVD in VMT patients. Combined intravitreal injection of TPA and Bevacizumab can induce PVD and improve BCVA and decrease central macular thickness in eyes with retinal vascular diseases.

THE EFFECT OF ELECTIVE CATARACT EXTRACTION BY PHACOEMULSIFICATION IN EYES WITH VITREOMACULAR TRACTION SYNDROME

To evaluate the effect of cataract extraction (CE) by phacoemulsification on the vitreomacular interface (VMI) of eyes with preexisting vitreomacular traction (VMT). Retrospective, observational case series. Patients with VMT who elected to proceed with CE, before any vitreoretinal intervention, were studied. Eyes with at least a 12-month follow-up period were included. The status of the vitreomacular adhesion at different time points was assessed using spectral-domain optical coherence tomography. The best-corrected visual acuity was recorded at different time points. Other macular and systemic comorbidities were documented. Fifteen eyes from 15 phakic patients with symptomatic VMT were included. Six of them were male subjects. Seven patients had diabetes mellitus and two of them also had nonproliferative diabetic retinopathy. The preoperative macular comorbidities included macular hole in six eyes (Stage 1 in 3 eyes and Stage 2 or 3 in another 3 eyes), epiretinal membrane in five eyes, and cystoid macular edema in four eyes. After uncomplicated CE, the VMT was released in 5 eyes, whereas in 10 eyes, CE did not significantly change the status of the vitreomacular adhesion. Three of 3 eyes with preexisting full-thickness macular hole (Stage 2 or 3 macular hole) were found to have Stage 4 macular hole shortly after CE. In seven of seven patients with diabetes mellitus, the status of the vitreomacular interface did not change after CE. Eventually, 7 of 15 patients underwent additional pars plana vitrectomy. Compared with the baseline vision, and vision before other interventions, the visual acuity after CE improved in 5 patients, remained unchanged in 7 patients, and decreased in the 3 patients with Stage 2 or 3 macular hole. The mean preoperative and early postoperative visual acuity was 20/59 and 20/68, respectively (P > 0.05). The effect of CE in phakic eyes with known VMT varies significantly. In the current case series, every eye with VMT and Stage 2 or 3 macular hole ended up with Stage 4 macular hole, although the VMT did not change significantly in the eyes of diabetic patients. Studies with larger sample size are needed to further elucidate the impact of elective CE on VMT.

Morphological Reconstitution and Persistent Changes After Intravitreal Ocriplasmin for Vitreomacular Traction and Macular Hole.

Purpose: To assess the long-term anatomical and functional findings in patients with symptomatic vitreomacular traction (VMT), with or without full thickness macular hole (FTMH), after eye treatment with intravitreal ocriplasmin injection (IOI). Methods: This longitudinal case series includes 51 eyes from 51 symptomatic patients with VMT (<800 μm) who received a single IOI (Jetrea® 0.125 mg); 21 cases with an FTMH (<400 μm) were included. Best-corrected visual acuity (BCVA) and optical coherence tomography findings were recorded before IOI, and 1 day to 24 months thereafter. Data are presented as mean ± standard deviation. Results: Mean adhesion size before injection was 345 ± 146 μm. In 34 eyes (67%), complete release of VMT was observed; whereas VMT persisted in 17 eyes (33%). The latter included 15 of the 21 eyes (71%) with FTMH, 15 of which underwent pars plana vitrectomy and inner limiting membrane peeling. BCVA improved from (logarithm of the minimal angle of resolution [logMAR]) 0.41 ± 0.03 before injection to 0.32 ± 0.03 after 1 month and 0.23 ± 0.05 after 6 months and remained stable thereafter (0.24 ± 0.06 after 24 months of follow-up). Forty-five percent of the eyes presented submacular deposits soon after IOI that were not functionally relevant; 61% completely resolved by 12 months. Except floaters that disappeared within 48 h, no other adverse events were reported during follow-up. Conclusions: Treatment with ocriplasmin in a real-life setting showed an overall efficacy of 67% in patients with symptomatic VMT, with better results evident in the absence of an FTMH (70% vs. 62% VMT release) and a visual gain for over 2 years.

Treatment of Vitreomacular Traction with Intravitreal Injection of Perfluoropropane.

To evaluate the effect of one intravitreal injection of expansile gas in the treatment of vitreomacular traction (VMT). Aretrospective review of eyes with VMT treated with singl injection of 0,3 ml of 100% C3F8 gas was performed. The procedure was performed on an outpatient basis under topical anesthesia. Twelve consecutive patient (14 eyes) with symptomatic VMT underwent pneumatic vitreolysis. Mean extend of vitreomacular adhesion was 490,5 µm (408-751). Aposterior vitreous detachment developed in 13 eyes (92,9 %) after asingle gas injection, in 11 eyes (84,6 %) during the first month of follow-up, in 2 eyes within two month of injection. Mean baseline and last BCVA were 0,5 (0,16-0,18) and 0,67 (0,2-1,0) respectively (p.

Short-term changes in posterior vitreous cortex following intravitreal ocriplasmin for symptomatic vitreomacular traction syndrome: a prospective study.

To describe and analyze short-term posterior vitreous abnormalities following intravitreal ocriplasmin in eyes with symptomatic vitreomacular traction syndrome (VMT). In this institutional, prospective and interventional study enrolled patients with symptomatic focal VMT syndrome treated with intravitreal ocriplasmin. In all cases, spectral-domain optical coherence tomography scans were quantitatively and qualitatively analyzed preoperatively and at 1 and 4weeks postoperatively. Twenty-three patients, of which 5 were males and 18 females, with a mean age of 69.5 ± 8.2 years were included in this study. Postoperatively, VMT resolved in 11 of 23 eyes (47.8%). In 9 out of 11 cases (81.8%), VMT resolved by postoperative week 1, whether in the remaining 2 (18.2%) anatomical restoration, was diagnosed at postoperative week 4. At postoperative week 1, a foveolar detachment was detected in 9 out of 23 eyes (39.1%). The foveolar detachment resolved all but one eye by the end of postoperative week 4. At the end of the follow-up period, the presence of subretinal fluid was detected in 7 out of 9 eyes (77.8%), and it was significantly associated with a shrinkage of the posterior vitreous cortex (p < 0.006). At the end of the follow-up period, visual acuity was significantly higher in those eyes with VMT resolution (p < 0.001). Intravitreal ocriplasmin is effective for the treatment of patients with VMT. The postoperative presence of posterior hyaloid shrinkage may be associated with higher traction over the foveal area and the appearance of foveolar detachment.

Longitudinal ellipsoid zone and subretinal fluid mapping following ocriplasmin injection in the prospective observational ORBIT trial

BackgroundOcriplasmin is approved for the treatment of symptomatic vitreomacular traction (VMT). However, several retrospective reports have identified ellipsoid zone (EZ) alterations on spectral domain optical coherence tomography (SDOCT) after ocriplasmin...

Flare changes after intravitreal injection of ocriplasmin in symptomatic vitreomacular traction syndrome.

To evaluate the changes in anterior chamber flare after a single intravitreal injection of ocriplasmin (125μg), in patients with symptomatic vitreomacular traction syndrome (VMT). An institutional review board-approved single-center not randomized prospective study. Fifteen eyes of fifteen patients (9 women, 6 men) underwent intravitreal injection with ocriplasmin for symptomatic VMT (width of attachment ≤ 1500μm). Anterior segment flare was measured with a laser flare meter (Kowa) before intravitreal injection and 1day, 1week, 1month after injection. The changes in flare were analyzed; the resolution of VMT was evaluated with spectral-domain OCT. The mean anterior chamber flare was 10.5 ± 1.9 photons per millisecond (photons/ms) before the injection. After 1day it increased to 13.6 ± 2.7 photons/ms (p = 0.027) and after 1week to 14.4 ± 2.5 photons/ms (p = 0.005); after 1month it decreased to 12.3 ± 2.3 photons/ms (p = 0.123). At 1day and 1week after injection, mean anterior chamber flare of fellow eyes was significantly lower than study eyes, while at 1month this difference was not significant (12.3 ± 2.3 vs. 10.5 ± 1.8 photons/ms, p = 0.124, for study and fellow eyes). There was no statistically significant difference in the changes in flare between women and men or between phakic (N = 10) and pseudophakic (N = 5) eyes. No eye demonstrated intraretinal damage at any time-point. Also, 9 eyes showed resolution of VMT while 6 eyes demonstrated persistence of VMT. Our study shows that intravitreal injection of ocriplasmin can be a safe and effective approach to treat symptomatic VMT syndrome in selected patients.

This issue of Acta

This issue of Acta

Italian real-life experience on the use of ocriplasmin

ObjectiveTo evaluate the success of an intravitreal injection of ocriplasmin to release symptomatic vitreomacular traction (VMT) and close a full-thickness macular hole.Methods and analysisAn observational retrospective multicentre study conducted in...

Pneumatic Vitreolysis for the Treatment of Symptomatic Vitreomacular Traction: A Prospective Pilot Study

Purpose: The purpose of this study was to determine the efficacy of pneumatic vitreolysis in the treatment of symptomatic focal vitreomacular traction (VMT). Methods: Patients choosing intravitreal gas injection as their preferred treatment for symptomatic VMT were invited to participate in this prospective study; 0.3 mL of perfluoropropane gas was injected. Optical coherence tomography was performed pre-and postprocedure to determine the proportion of eyes showing release of VMT. Results: Nine eyes of nine participants were included in the study, with a mean follow-up of 5.0±1.8 months. Gas injection resulted in the release of VMT in 7 of 9 eyes (78%) during the course of the study. Both eyes in which the VMT failed to release also showed an improvement in central macular anatomy. Mean visual acuity improved from logarithm of the minimum angle of resolution (logMAR) 0.33±0.14 (Snellen equivalent, ∼20/42) to logMAR 0.24±0.21 (Snellen, ∼20/35) at final follow-up ( P = .03); 8 of 9 patients (89%) reported a subjective improvement in their presenting symptoms and/or vision during the study period. The mean maximum foveal thickness of 480 ± 22 μm at baseline reduced to 282 ± 94 μm by the time of the final visit ( P = .002). Two patients had retinopexy for retinal breaks/suspect breaks. Conclusions: Pneumatic vitreolysis is an effective treatment for symptomatic VMT and may offer cost savings for patients and/or health services.