Vitreomacular Traction Release Research Articles

Bilateral Spontaneous Release of Vitreomacular Traction

Bilateral Spontaneous Release of Vitreomacular Traction

Non-Surgical Pneumatic Repair of Stage 2 Macular Holes

Purpose: We report anatomical and functional outcomes of gas injection for small-medium full thickness macular holes (FTMH) with vitreomacular traction (VMT). Methods: This retrospective-comparative case series included patients with stage 2 FTMH who underwent intravitreal injection of perfluoropropane (C3F8) or sulfur hexafluoride (SF6) gas. Clinical evaluation included B-scan ultrasonography and spectral-domain optical coherence tomography (OCT) to assess post-procedure MH closure, vitreous status, and visual outcomes. Results: There were five men and seven women with a mean age of 63.75 years (range: 54-76). The median duration of symptoms was 8.5 months (range: 2-52 months). The mean BCVA at presentation was 0.51 LogMAR (Snellen equivalent 20/65). The mean macular hole aperture size was 206 (range: 127-334). In eight (67%) patients, FTMH closed after gas injection. All the four open holes underwent vitrectomy. The median follow-up was 11 months (range: 2-53 months). At the last follow-up, all the patients had type 1 MH closure; BCVA improved in 10 (83%). The mean post-treatment BCVA was 0.28 LogMAR (Snellen equivalent 20/38). One patient developed retinal tears, which were successfully treated with barrage laser photocoagulation. Conclusion: Intravitreal gas injection is a valid treatment modality for non-surgical macular hole closure, especially in smallmedium FTMH. Gas-assisted PVD induction and release of VMT provides a viable option for patients unwilling/unfit for vitrectomy, with no carry-over disadvantage in subsequent surgery in case of macular hole non-closure.

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.

Closure of idiopathic full-thickness macular hole after intravitreal C3F8 injection without vitreomacular traction release: A case report and review of literature.

To describe a successful closure of macular hole without release of vitreomacular traction (VMT) after intravitreal perfluoropropane (C3F8) gas injection. A 54-year-old woman was referred to our clinic with the history of declined vision after a period of distorted vision in her right eye. After dilated fundus examination and performing optical coherence tomography (OCT), a V-shaped VMT complicated by full-thickness macular hole was diagnosed and she underwent pneumatic vitreolysis using intravitreal C3F8 gas injection. After 12 weeks, her visual acuity was significantly improved and fundus examination and OCT revealed that the macular hole was completely resolved despite persisted VMT. Intravitreal gas injection would be a promising option to manage idiopathic macular holes not only by releasing the vitreous traction on the macula, but also through some not proven or even unknown mechanisms.

PREDICTIVE FACTORS OF SPONTANEOUS RELEASE OF VITREOMACULAR TRACTION: A Systematic Review and Meta-Analysis.

To review predictive factors of spontaneous vitreomacular traction (VMT) release. A systematic literature search was performed on Ovid MEDLINE, Embase, and Cochrane Library. Studies comparing spontaneously released VMT to persistent VMT were included. A meta-analysis was performed using a random effects model, and weighted mean difference, risk ratio (RR), and 95% confidence intervals (95% CI) were reported as appropriate. Of a search of 258 studies, 12 studies were included, from which 272 of 934 eyes (29%) underwent spontaneous release. Mean age was 70.0 years, 37.2% of patients were men, and mean follow-up was 22.0 months. Significant predictive factors for spontaneous release were smaller VMT diameter (n = 177; weighted mean difference = -212.48 µm, 95% CI = [-417.36, -7.60], P = 0.04), epiretinal membrane absence (n = 162; RR = 2.17, 95% CI = [1.18, 3.97], P = 0.01), and right eye involvement (n = 76; RR = 2.10, 95% CI = [1.14, 3.88], P = 0.02). Nonsignificant factors were age, initial best-corrected visual acuity, sex, ocular comorbidity, fellow-eye posterior vitreous detachment, previous intravitreal injection, and VMT classification with focal defined as ≤400 µm. Mean release time was 15.3 months (n = 212). Mean best-corrected visual acuity improved from 0.34 ± 0.21 (Snellen 20/44) to 0.20 ± 0.58 logMAR (Snellen 20/32) postrelease (n = 121). Smaller VMT diameter, epiretinal membrane absence, and right eye involvement may support spontaneous VMT release. If patients have tolerable symptoms, clinicians may consider observation in patients with these predictive factors.

Idiopathic Vitreomacular Traction Managed with Initial Observation: Clinical Course and Outcomes

To review the clinical course and outcomes of patients with idiopathic vitreomacular traction (VMT) managed initially by observation. Retrospective chart review including patients with idiopathic VMT based on clinical symptoms and findings on OCT between January 1, 2015, and February 15,2021. The study included 436 eyes of 317 patients with a mean age of 72.2 years ± 8.9 at initial visit and mean follow-up time of 34 months ± 19.2. Vitreomacular traction severity grade was ascribed to each patient using previously published grading criteria. Grade 1 denoted incomplete cortical vitreous separation with attachment at the fovea and visible distortion of the foveal surface. Grade 2 included intraretinal cysts or clefts along with grade 1 findings. Grade 3 included subfoveal fluid along with grade 2 traits. The rate of spontaneous release, grade at baseline compared with grade at final follow-up, and outcomes of interventions, if performed. At baseline, mean best corrected visual acuity (BCVA) was 20/40. Baseline OCT demonstrated grade 1 VMT in 212 eyes (48.6%), grade 2 VMT in 172 eyes (39.4%), and grade 3 VMT in 52 eyes (11.9%). Among eyes that were initially grade 1, 25.0% had spontaneous release of VMT (median, 290.0 days; mean, 404.5 days ± 323.9), 50.9% remained stable, and 10.4% worsened. Among eyes that were initially grade 2, 14.5% had spontaneous release of VMT (median, 570.0 days; mean, 692.9 days ± 477.5), 55.2% remained stable, 4.7% improved, and 2.3% worsened. Among eyes that were initially grade 3, 5.8% had spontaneous release of VMT (median, 790.0 days; mean, 839.3 days ± 246.7), 28.8% remained stable, and 5.8% improved. Of the 436 eyes, macular hole development occurred in 42 eyes (9.6%). Pars plana vitrectomy was performed in 94 of 436 eyes (21.6%) with mean BCVA before pars plana vitrectomy of 20/78 and final follow-up BCVA of 20/55. This study demonstrates the generally stable clinical course of VMT when managed initially by observation. Stable VMT grade was the most frequent outcome, and eyes with grade 1 VMT were more likely to undergo spontaneous release than eyes with grade 2 or3.

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.

Resolution of outer retinal abnormalities in eyes with vitreomacular traction without macular hole in the OASIS trial

Background/aimsTo describe the clinical impact of external limiting membrane (ELM) disruption, ellipsoid zone (EZ) disruption and subretinal fluid (SRF) seen on optical coherence tomography (OCT) in eyes with vitreomacular traction...

Pars plana vitrectomy and visual stimulation for treatment of vitreomacular traction secondary to toxoplasmosis retinochoroiditis in a 5-year-old child

Objective: A unusual case of ocular toxoplasmosis with significant vitreomacular traction is reported. The patient improved significantly following pars plana vitrectomy combined with visual stimulation and occlusion therapy. Methods: The case of a 5-year-old girl with significant unilateral vision loss associated with vitreous condensation and macular traction is described. Results: Pars plana vitrectomy was carried out for vitreomacular traction release. This was followed by visual stimulation and occlusion therapy. Significant improvement was observed. Conclusion: Despite structural damage, the combination [...]

Anatomical and functional outcomes of pneumatic vitreolysis for treatment of vitreomacular traction with and without macular holes

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.

Predicting the individual probability of macular hole closure following intravitreal ocriplasmin injections for vitreomacular traction release using baseline characteristics

The primary objective was to create and establish a new formula that predicts the individual probability of macular hole closure for eyes with full thickness macular holes (FTMH) accompanied by vitreomacular traction (VMT) which received enzymatic vitreolysis using intravitreally administered ocriplasmin. The secondary objective was to evaluate the forecast reliability of a previously published formula for VMT resolution in VMT-only eyes (OddsIVO-Success = eIntercept × ORyears × ORln(µm); ProbabilityIVO-Success = OddsIVO-Success/(OddsIVO-Success + 1)) on VMT resolution using the current dataset of eyes with FTMH accompanied by VMT. Retrospective analysis of the OASIS, ORBIT, and INJECT-studies. Patients with FTMH and VMT with complete information (n = 213) were included. The effect of gender, age, FTMH diameter, lens status and the presence of epiretinal membranes (ERM) on FTMH closure was assessed using separate univariate logistic regression analyses. With regard to VMT release separate univariate regression analyses were carried out and results were compared with formerly published data of VMT resolution in eyes with VMT only. Overall, 126 eyes (63%) experienced VMT resolution within 28 days. Younger age (p < 0.0001) and VMT diameter (p = 0.041) had a significant impact on VMT release. Overall, 81 eyes (38%) treated with ocriplasmin showed FTMH closure within 28 days. Univariate analysis of the different predictors analyzed revealed that FTMH diameter < 250 µm had a significant impact on treatment success (p = 0.0495). It was not possible to calculate and establish a new multivariate formula that can predict the individual FTMH closure probability for eyes with FTMHs and VMT. However, the results of VMT release prediction in eyes with FTMHs accompanied by VMT matched the prediction of VMT release in eyes with VMT only when using the previously published formula. All in all, predictors for calculating the individual probability of VMT resolution on the one hand and FTMH closure on the other hand are different suggesting diverse pathophysiological mechanisms.

NATURAL COURSE OF VITREOMACULAR TRACTION IN EYES WITH DIABETIC RETINOPATHY AND FACTORS ASSOCIATED WITH SPONTANEOUS RELEASE.

The aim of this study was to determine the natural course of vitreomacular traction (VMT) in patients with diabetic retinopathy and to evaluate the factors associated with VMT relief. Seventy-four eyes of 65 patients with VMT accompanying diabetic retinopathy were evaluated retrospectively. The presence of intravitreal injection and the presence of panretinal photocoagulation were obtained from the medical records of the patients. Spontaneous release of VMT, the horizontal length of vitreomacular traction, the presence of hyperreflective retinal spots, the presence of the epiretinal membrane, and the grade of VMT were evaluated from the spectral-domain optical coherence tomography images. Factors associated with the spontaneous release of VMT were evaluated by logistic regression analysis. Spontaneous release was observed in 28 eyes (37.8%). The horizontal length of VMT was lower in the release of the VMT group compared with the persistent VMT group (P = 0.03). The persistent VMT group had a higher rate of hyperreflective retinal spots and epiretinal membrane compared with the release of the VMT group (respectively; P = 0.003 and P = 0.031). No statistically significant difference was observed between the release of VMT and persistent VMT groups in terms of intravitreal injection and panretinal photocoagulation treatment (respectively; P = 0.938 and P = 0.36). The absence of hyperreflective retinal spots was the most important prognostic factor for the spontaneous release of VMT (P = 0.029). Spontaneous release of VMT observed higher rates of patients without hyperreflective retinal spots, epiretinal membrane, and patients with lower horizontal length of VMT.

Pneumatic Vitreolysis with Perfluoropropane for Vitreomacular Traction with and without Macular Hole: DRCR Retina Network Protocols AG and AH

To evaluate pneumatic vitreolysis (PVL) in eyes with vitreomacular traction (VMT) with and without full-thickness macular hole (FTMH). Two multicenter (28 sites) studies: a randomized clinical trial comparing PVL with observation (sham injection) for VMT without FTMH (Protocol AG) and a single-arm study assessing PVL for FTMH (Protocol AH). Participants were adults with central VMT (vitreomacular adhesion was ≤3000 μm). In Protocol AG, visual acuity (VA) was 20/32 to 20/400. In Protocol AH, eyes had a FTMH (≤250 μm at the narrowest point) and VA of 20/25 to 20/400. Pneumatic vitreolysis using perfluoropropane (C3F8) gas. Central VMT release at 24 weeks (Protocol AG) and FTMH closure at 8 weeks (Protocol AH). From October 2018 through February 2020, 46 participants were enrolled in Protocol AG, and 35 were enrolled in Protocol AH. Higher than expected rates of retinal detachment and tear resulted in early termination of both protocols. Combining studies, 7 of 59 eyes (12% [95% CI, 6%-23%]; 2 eyes in Protocol AG, 5 eyes in Protocol AH) that received PVL developed rhegmatogenous retinal detachment (n= 6) or retinal tear (n= 1). At 24 weeks in Protocol AG, 18 of 23 eyes in the PVL group (78%) versus 2 of 22 eyes in the sham group (9%) achieved central VMT release without rescue vitrectomy (adjusted risk difference, 66% [95% CI, 44%-88%]; P< 0.001). The mean change in VA from baseline at 24 weeks was 6.7 letters in the PVL group and 6.1 letters in the sham group (adjusted difference, -0.8 [95% CI, -6.1 to 4.5]; P= 0.77). In Protocol AH, 10 of 35 eyes (29% [95% CI, 16%-45%]) achieved FTMH closure without rescue vitrectomy at 8 weeks. The mean change in VA from baseline at 8 weeks was -1.5 letters (95% CI, -10.3 to 7.3 letters). In most eyes with VMT, PVL induced hyaloid release. In eyes with FTMH, PVL resulted in hole closure in approximately one third of eyes. These studies were terminated early because of safety concerns related to retinal detachments and retinal tears.

Visual functional changes after ocriplasmin injection for vitreomacular traction: A microperimetric analysis.

PURPOSE:The purpose is to evaluate functional changes after ocriplasmin injection to treat vitreomacular traction (VMT) by microperimetry.MATERIALS AND METHODS:Prospective interventional study on patients underwent an intravitreal ocriplasmin injection. Optical coherence tomography, best-corrected visual acuity (BCVA) test, and microperimetry were performed at baseline, 1 week, 1 and 3 months. Microperimeter recorded retinal sensitivity (RS) and central retinal sensitivity (CRS) at central 12° and 4°, respectively, and fixation as bivariate contour ellipse area (BCEA) at 68%, 95%, and 99% of fixation points. Functional parameters were analyzed in patients who had (Group A) or not (Group B) VMT release.RESULTS:Twenty-one patients including 18 with VMT and 3 with VMT plus macular hole (MH) were treated. Eleven patients achieved VMT resolution including all cases with MH that achieved hole closure. An impairment of BCVA, RS and CRS (P < 0.01; P < 0.001; P = 0.001, respectively) was reported at 1 week followed by a significant improvement (BCVA, P = 0.001; RS, CRS, P = 0.02) at 3 months. The early impairment of visual acuity and sensitivity significantly occurred in Group B (P ≤ 0.01) while their recovery significantly occurred in Group A (P < 0.01). BCEA significantly increased in dimension (68%, P = 0.01; 95%, P = 0.03) at 1 week, subsequently returning to near baseline values over follow-up. Only in Group A, fixation stability significantly improved at 3 months.CONCLUSION:Microperimetry confirms an early and reversible functional impairment after ocriplasmin injection regardless VMT resolution. If a greater decrease in function could occur in the eyes without VMT resolution, a better functional recovery could occur in the event of VMT resolution.

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.

COMBINED PNEUMATIC AND ENZYMATIC VITREOLYSIS FOR SEVERE CASES OF VITREOMACULAR TRACTION.

To evaluate the efficacy of combined pneumatic and enzymatic vitreolysis for treatment of severe cases of vitreomacular traction (VMT). We analyzed a retrospective, consecutive series of five patients diagnosed with severe VMT refractory to pneumatic vitreolysis who then received an additional ocriplasmin injection while their gas bubble from pneumatic vitreolysis was still present between February 2015 and February 2019. Vitreomacular traction release was confirmed using spectral-domain optical coherence tomography. Four of the five patients treated with combined pneumatic and enzymatic vitreolysis achieved VMT release by Day 28, and all cases eventually achieved complete VMT release. In addition to having VMT refractory to pneumatic vitreolysis, patient characteristics included broad adhesion diameter (>1,500 µ m, n = 1), presence of epiretinal membrane (n = 2), age >65 years (n = 4), and pseudophakia (n = 1). The visual acuity improved by three or more lines at 6 months in both of the patients with initial vision worse than 20/50 on an Early Treatment Diabetic Retinopathy Study chart but not in those whose vision was already fairly good (i.e., visual acuity >20/60). None of the patients experienced the following complications after receiving this combined treatment: retinal tears or detachments, vitreous floaters, and ellipsoid zone changes. Sequential, combined pneumatic and enzymatic vitreolysis resulted in VMT release in all 5 cases (4 cases by 28 days) and may be a potentially useful alternative to surgical intervention for refractory VMT cases.

IOCT-assisted macular hole surgery: outcomes and utility from the DISCOVER study

Background/aimsThis study aimed to characterise the clinical outcomes and utility of intraoperative optical coherence tomography (iOCT)-assisted macular hole (MH) repair.MethodsThis was a post hoc analysis of eyes in the Determinationof...

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.

Spontaneous closure of stage 3 full-thickness macular hole after vitreomacular traction release in a renal transplant patient -a case report

The aim of our study is to describe spontaneous closure of a macular hole (MH) after vitreomacular traction (VMT) release in a 62-year-old patient with a history of renal transplant 6 months ago who was on tacrolimus, mycophenolate mofetil, nifedipine, and atorvastatin. The patient presented to our practice complaining of poor vision in his right eye for the past 6 months. On examination, he showed a full-thickness MH, Stage III, and VMT in the right eye evident in OCT which is an indication for surgical intervention. However, we elected to observe the patient upon his request. On further follow-up, visual acuity improved and OCT showed release of the VMT and closure of the MH. We attribute the release of the VMT to vitreolytic properties of atorvastatin. Our report highlights the possibility of observation of Stage 3 MHs in patients on atorvastatin as an option for the management.

A surgical cause of pseudopapilledema

We report a case of vitreopapillary traction mimicking optic disc swelling in a 73-year-old female with pseudophakia in the left eye and satisfactory postoperative vision of 6/6 and N5 two years prior. She presented with insidious onset of blurred vision in her left eye for two months. She was referred to Universiti Kebangsaan Malaysia Medical Centre (UKMMC) for further investigations of apparent optic disc swelling in the left eye by a general ophthalmologist. Her left eye vision was 6/18, pinhole 6/12, with near vision at N6. There was no relative afferent pupillary defect and anterior segment examination was normal. Examination of the posterior segment revealed a pink optic disc with blurred and elevated margins without hyperaemia. Vessels of the optic nerve head appeared normal and a lamellar macular hole was present with dull foveal reflex clinically. Right eye examination was normal. Optical coherence tomography (OCT) of the left eye using the raster line scan showed vitreopapillary traction surrounding the optic disc and vitreomacular traction (VMT) with lamellar macular hole. The patient was counselled for surgical release of VMT, however, she opted for conservative management.&#x0D; Peripapillary vitreoretinal traction is a rare cause of pseudo-optic disc swelling. Thorough fundus examination with the help of OCT is crucial in making a prompt diagnosis, preventing unnecessary investigations, and evaluating other retinal pathologies which may benefit from treatment.&#x0D;