Vitreomacular traction release: Finding the edge

Background: Vitreomacular traction (VMT) is a commonly encountered entity in our routine practice. The key question is whether to observe or operate by clinical and imaging based judgement of the visual prognosis in every case. Purpose: This video encapsulates diagnostics, surgical method, and prognosis in a case of VMT released with vitrectomy. Synopsis: A 56-year-old businessman was diagnosed with VMT in the OPD and was advised surgical release of the same. The patient was extremely keen to know the visual prognosis, where the OCT imaging helped. The surgical method demonstrates the method to find the edge of the PVD to release the traction. Also, a simple ILM peel procedure has been described to reduce recurrences in cases like these. Highlights: 1. Judging the prognosis in VMT cases on basis of imaging. 2.Finding the edge (FTE) method of inducing the PVD. 3. ILM peeling simplified

Pars plana vitrectomy and visual stimulation for treatment of vitreomacular traction secondary to toxoplasmosis retinochoroiditis in a 5-year-old child / Vitrectomia via pars plana e estimulação visual para tratamento da tração vitreomacular secundária à retinocoroidite por toxoplasmose em criança de 5 anos

ABSTRACT 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 of properly indicated surgery and amblyopia management strategies allowed the achievement of maximum vision goals in this case, suggesting structural damage may be associated with functional amblyopia.

RESUMO Objetivo: Relata-se um caso de apresentação atípica de toxoplasmose ocular, com importante tração vitreomacular. A paciente apresentou melhora significativa após vitrectomia via pars plana, com estimulação visual e oclusão. Métodos: Descreve-se o caso de uma menina de 5 anos, com importante perda de visão unilateral associada à condensação vítrea e à tração macular. Resultados: Foi realizada vitrectomia via pars plana para alívio da tração vitreomacular, seguida de estimulação visual e oclusão. Foi observada melhora significativa. Conclusão: Apesar dos danos estruturais, a combinação de cirurgia bem indicada com estratégias de tratamento da ambliopia permitiu alcançar o máximo do potencial visual nesta paciente, sugerindo que os danos estruturais podem estar associados à ambliopia funcional.

Research progress of pseudophakic cystoid macular edema / 国际眼科杂志(Guoji Yanke Zazhi)

@#Cataract is the most common blinding eye disease in our country. Cataract phacoemulsification combined with intraocular lens implantation is the first choice for cataract surgery, with advantages of a small incision, mild anterior chamber reaction, repaid recovery and small astigmatism of corneal. However, there are still some patients failed to achieve ideal visual quality after surgery due to various reasons even if the surgery is successful. Cystoid macular edema(CME)is one of the common complications in pseudophakic eyes affecting postoperative visual quality after cataract surgery. Recent studies on pseudophakic cystoid macular edema(PCME)are reviewed in this paper.

Intravitreal injection of C3F8 in the treatment of vitreomacular traction syndrome / 中华眼底病杂志

Objective To evaluate the efficacy of single intravitreal injection of C3F8 in treating vitremacular traction (VMT) syndrome.Methods A retrospective case series of 38 eyes of 36 patients affected with VMT syndrome in Department of Ophthalmology,Central Theater Command General Hospital from March 2016 to June 2017 were enrolled in this study.There were 16 males (16 eyes) and 20 females (22 eyes),with the mean age of 64.1 1 ± 9.49 years and the mean courses of 151.55 ± 127.87 days.All the patients received an intravitreal injection of 0.3 ml of 100％ C3F8 within one week.The BCVA examination was performed using the international standard visual acuity chart,which was converted into logMAR visual acuity.The severity of metamorphopsia was detected using M-charts.The extent of vitreomacular adhesion (VMA),central macular thickness (CMT) and the status of ellipsoid zone (EZ) were assessed with spectral-domain OCT at baseline and each month after treatment.The average BCVA was 0.58± 0.22.The mean horizontal metamorphopsia (MH)and vertical metamorphopsia (MV) were 0.34±0.30 and 0.50±0.42,respectively.The mean CMT was 415.15 ± 89.59 μm.The mean horizontal VMA was 1168.68± 400.61 μm (30 eyes with VMA ≤ 1500 μtm and 8 eyes with VMA＞ 1500 μm).The mean vertical VMA was 976.89±295.92 μtm.There were 22 eyes with integrity EZ and 16 eyes without integrity EZ,33 eyes with crystalline lens and 5 eyes with IOL.The mean follow-up time was 10.7 months.The differences in BCVA,MH,MV,CMT,the integrity of EZ before and after treatment were analyzed.The VMT release rates were assessed.The Spearman rank correlation analysis was performed to investigate the relationship of VMT release rates with the data at baseline.Results Vitreomacular traction release occurred in 29 of 38 eyes by the final follow-up visit,the VMT release rate was 76.3％.VMT release occurred and the average time of VMT release occurred was 2.2 weeks.VMT persisted in 7 eyes,in the rest two eyes,one eye developed a retinal detachment and another eye formed macular hole,both eyes responded to vitrectomy.At 6 months after treatment,the average logMAR BCVA was 0.43±0.23,the mean MH and MV were 0.25± 0.23 and 0.24± 0.23,the mean CMT was 310.61 ± 63.10 pm.Among 16 eyes without integrity EZ before treatment,there were 9 eyes with integrity EZ at 6 months after treatment.There were 16 eyes with integrity EZ and 9 Compared with baseline,the mean BCVA at 6 months after treatment was significantly increased (F=3.779,P=0.037),but the MV (F=4.958,P =0.003) and CMT (F=13.419,P＜0.001) were significantly decreased,the integrity of EZ was improved significantly (22=5.050,P=0.025).The VMT release correlated inversely with the extent of horizontal VMA,BCVA,and CMT at baseline (r=-0.514,-0.348,-0.429;P=0.009,0.001,0.038).Conclusion Intravitreal injection of C3F8 can induce a posterior vitreous detachment and release vitreomacular traction,it is an efficient and safe treatment for VMT syndrome.It can improve the visual acuity,metamorphopsia and foveal morphology in patients with VMT syndrome.

The current status and progress of ocriplasmin in treating vitreomacular interface diseases / 中华眼底病杂志

As a potent collagenase activator,ocriplasmin is a recombinant truncated form of serine protease that retains the protease activity of plasmin.Pre-clinical animal experiments,clinical trials and recent clinical studies all indicated a promising outcome of intravitreal injection of ocriplasmin to treat vitreomacular interface diseases,including vitreomacular adhesion (VMA),vitreomacular traction (VMT) and full-thickness macular hole.Ocriplasmin was approved by the Food and Drug Administration of USA in the management of symptomatic VMA,and by the European Medicines Agency in treating VMT-associated macular hole with less than or equal 400 pm.Further randomized controlled clinical trials are needed for further comprehensive observation and evaluation on its efficiency,safety and other noteworthy issues.

A comparative study on OCT before and after the operation for vitreomacular traction syndrome / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To make a contrast and then analyze the difference of optical coherence tomography (OCT) before and after vitreomacular traction syndrome (VTS) was performed.METHODS: The clinical date of 11 evaluable eyes of 11 patients with VTS who were diagnosed by OCT and underwent 25G vitreous surgery from January 2013 to January 2014 were retrospectively analyzed.Patients were followed up for an average of 6mo, to observe the visual acuity and OCT examination of the patient before and after operation.We compared the changes of retinal thickness and local morphology before and after operation.RESULTS: After vitreous retraction, 6 eyes improved, 2 eyes do not improve.One eye received macular membrane traction, in the operation the macular epiretinal membrane peeling, retrial membrane stripping and the triamcinolone acetonide intravitreal injection were given, but after the operation, the vision does not improve.Two eyes received vitreous combined with retinal macular membrane traction.In the operation, macular epiretinal membrane stripping was given, after the operation, visual acuity improved.The proportion of those with visual acuity of 0.1 or more increased from 46% before to 73% after the operation.Before operations, the mean central macular thickness was 619.27±195.13μm, 239.12±143.84μm after, which decreased significantly (P<0.05).CONCLUSION: Vitrectomy can effectively relieve the vitreous traction of the macula, and can prevent further decline in visual acuity and reduce macular edema as well as improve the visual acuity of some patients.So, OCT has important guiding significance on the diagnosis and prognosis of this group.

Macular hole formation and spontaneous closure after vitrectomy for rhegmatogenous retinal detachment documented by spectral‑domain optical coherence tomography: Case report and literature review.

This case report describes macular hole (MH) formation and spontaneous closure after vitrectomy for rhegmatogenous retinal detachment (RRD) repair. A 58‑year‑old man referred with a macula‑off superior RRD, in whom vitrectomy was performed. MH with vitreomacular traction (VMT) caused by the posterior vitreous cortex remnants developed 2 weeks after vitrectomy. Four weeks postoperatively, optical coherence tomography revealed resolution of the VMT and spontaneous closure of MH without providing any treatment. This is the first report of an MH formation and spontaneous closure after vitrectomy for RRD. This suggests that the VMT mediated by the posterior vitreous cortex remnants has an important role in the development of secondary MH.

Effects of Vitreomacular Traction on Ranibizumab Treatment Response in Eyes with Neovascular Age-related Macular Degeneration

PURPOSE: To investigate the effects of vitreomacular traction (VMT) on ranibizumab treatment response for neovascular age-related macular degeneration (AMD). METHODS: A retrospective review of 85 eyes of 85 patients newly diagnosed with neovascular AMD was conducted. Patients were eligible if they had received more than three consecutive monthly ranibizumab (0.50 mg) treatments and ophthalmic evaluations. Patients were classified into a VMT (+) group or VMT (-) group according to optical coherence tomography imaging. Best corrected visual acuity and central retinal thickness (CRT) measurements were obtained at three and six months after initial injection. RESULTS: One month after the third injection, mean visual acuity (VA) increases of 6.36 and 9.87 letters were observed in the VMT (+) and VMT (-) groups, respectively. The corresponding mean CRT values decreased by 70.29 microm and 121.68 microm, respectively. A total 41 eyes were identified as eligible for a subsequent fourth injection; 71.1% of patients (27 eyes) in the VMT (+) group but only 29.8% of patients in the VMT (-) group needed a subsequent fourth injection. Follow-up was extended to six months for 42 of the 85 enrolled patients (49.4%). The trends in VA and optical coherence tomography were found to be maintained at six-month follow-up. CONCLUSIONS: VA and CRT appeared to be more improved after ranibizumab treatment in the VMT (-) group compared to the VMT (+) group. VMT might antagonize the effect of ranibizumab treatment in a subpopulation of AMD patients.

Surgical Outcomes in Epiretinal Membrane According to the Presence of Vitreomacular Traction Syndrome

PURPOSE: To present preoperative macular structure deformities and surgical outcomes in idiopathic epiretinal membrane (ERM) patient according to the presence of vitreomacular traction syndrome (VMTS). METHODS: This retrospective observational study included 54 eyes of 51 patients with idiopathic ERM, who underwent pars plana vitrectomy with ERM and internal limiting membrane (ILM) peeling, and were followed for more than 6 months. Subjects were classified into 2 groups according to the presence of VMTS using preoperative optical coherence tomography (group 1: ERM without VMTS, 29 eyes; group 2: ERM with VMTS, 22 eyes). Preoperative macular structure deformity and surgical outcomes were compared and prognostic factors were analyzed. RESULTS: Group 1 (ERM without VMTS) included 29 eyes, and group 2 (ERM with VMTS) included 22 eyes. Group 2 had a significantly higher occurrence of lamellar macular hole and a significantly lower preoperative best-corrected visual acuity (BCVA) compared to group 1. However, final postoperative BCVAs were not significantly different between the groups because BCVA changed more in group 2. Preoperative macular structure deformities (irregular retinal surface, retinal thickening, lamellar macular hole, and cystoid macular edema) did not affect visual outcomes. The presence of photoreceptor inner segment/outer segment (IS/OS) junction disruption and preoperative BCVA were highly related with visual outcomes. CONCLUSIONS: BCVA significantly improved in idiopathic ERM patients who underwent pars plana vitrectomy with ERM and ILM peeling regardless of the presence of VMTS. There may be a stronger association of IS/OS junction disruption with visual acuity compared to VMTS in idiopathic ERM surgery.

Surgical Outcomes in Epiretinal Membrane According to the Presence of Vitreomacular Traction Syndrome

PURPOSE: To present preoperative macular structure deformities and surgical outcomes in idiopathic epiretinal membrane (ERM) patient according to the presence of vitreomacular traction syndrome (VMTS). METHODS: This retrospective observational study included 54 eyes of 51 patients with idiopathic ERM, who underwent pars plana vitrectomy with ERM and internal limiting membrane (ILM) peeling, and were followed for more than 6 months. Subjects were classified into 2 groups according to the presence of VMTS using preoperative optical coherence tomography (group 1: ERM without VMTS, 29 eyes; group 2: ERM with VMTS, 22 eyes). Preoperative macular structure deformity and surgical outcomes were compared and prognostic factors were analyzed. RESULTS: Group 1 (ERM without VMTS) included 29 eyes, and group 2 (ERM with VMTS) included 22 eyes. Group 2 had a significantly higher occurrence of lamellar macular hole and a significantly lower preoperative best-corrected visual acuity (BCVA) compared to group 1. However, final postoperative BCVAs were not significantly different between the groups because BCVA changed more in group 2. Preoperative macular structure deformities (irregular retinal surface, retinal thickening, lamellar macular hole, and cystoid macular edema) did not affect visual outcomes. The presence of photoreceptor inner segment/outer segment (IS/OS) junction disruption and preoperative BCVA were highly related with visual outcomes. CONCLUSIONS: BCVA significantly improved in idiopathic ERM patients who underwent pars plana vitrectomy with ERM and ILM peeling regardless of the presence of VMTS. There may be a stronger association of IS/OS junction disruption with visual acuity compared to VMTS in idiopathic ERM surgery.

Spontaneous Resolution of Vitreoretinal-Iinterface Disorders

PURPOSE: To review the mechanisms and clinical patterns of spontaneous resolution of vitreoretinal interface disorders by analyzing cases and available literature on macular hole (MH), vitreoretinal traction (VMT), and epiretinal membrane (ERM). METHODS: Medical records and optical coherence tomography (OCT) images of patients with spontaneous resolution of MH, VMT, and ERM were reviewed. RESULTS: Two eyes with VMT, 3 eyes with idiopathic MH, 3 eyes of traumatic MH (including 1 eye with electrical burn), and 2 eyes with ERM showed spontaneous resolution. All eyes except traumatic MH reached a visual acuity better than 0.5 after resolution. All idiopathic MHs achieved anatomic closure in 6 months, and traumatic MHs in 1 month except for the electrical burn case. Seven out of 10 eyes experienced complete posterior vitreous detachment (PVD) during resolution. CONCLUSIONS: Some cases of vitreoretinal interface disorders can resolve spontaneously with complete PVD or other mechanisms. Indicators predicting spontaneous resolution should be considered in patients with vitreoretinal interface disorder.

The Short-term Effect of Triple Therapy for Diabetic Macular Edema With Vitreomacular Traction

PURPOSE: To evaluate the short-term effect and safety of a triple therapy on diabetic macular edema (DME) with vitreomacular traction. METHODS: Twenty four eyes from 24 subjects, diagnosed with DME with vitreomacular traction, were subjected to vitrectomy. Intravitreal triamcinolone acetonide injection and macular laser photocoagulation were conducted sequentially at one and 14 days after vitrectomy. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were recorded before surgery and at three and six months after triple therapy. RESULTS: The mean (+/-standard deviation [SD]) logarithm of the minimum angle of resolution BCVAs before, three, and six months after the triple therapy were 0.77+/-0.38, 0.48+/-0.27, and 0.47+/-0.36, respectively. The mean (+/-SD) CMTs before, three, and six months after the triple therapy were 407.9+/-127.1 micrometer, 272.4+/-104.6 micrometer, and 263.5+/-131.2 micrometer, respectively. The changes in BCVA at three and six months from treatment were statistically significant. Macular thickness decreased significantly at 3 and 6 months postoperatively. CONCLUSIONS: Triple therapy is a good therapeutic option for diabetic macular edema with vitreomacular traction to improve visual acuity and macular thickness.

Clinical Manifestation and Result of Vitrectomy of Vitreomacular Traction Syndrome

PURPOSE: To investigate the clinical manifestation and the result of vitrectomy in patients with vitreomacular traction syndrome. METHODS: Optical coherent tomography (OCT) was used to evaluate the clinical manifestation and the results of vitrectomy for 26 eyes with vitreomacular traction syndrome. RESULTS: Spontaneous relief of vitreomacular traction was achieved in 3 of 8 eyes after a mean follow-up duration of 9 months. One eye recovered visual acuity, but the other 2 eyes could not attain better visual acuity because of persistent sponge-like macular edemas. Six of 13 eyes (46%) improved by two or more lines of visual acuity after vitrectomy. The presence of simple macular cysts without sponge-like macular edemas or tractional retinal detachment seemed to be related to good results after vitrectomy. CONCLUSIONS: Vitrectomy is a preferable way to treat vitreomacular traction syndrome. Preoperative OCT could predict the surgical prognosis.

OCT-guided Hyaloid Release for Vitreomacular Traction Syndrome

PURPOSE: To evaluate the usefulness of OCT retinal mapping in determining the configuration of a vitreomacular adhesion and selecting a meridian for entry into the subhyaloid space in patients with vitreomacular traction syndrome. METHODS: Six consecutive patients (6 eyes) with vitreomacular traction syndrome underwent vitrectomy with peeling of posterior hyaloid. Ocular coherence tomography (OCT) retinal mapping was performed preoperatively. Access to the subhyaloid space was made by creating an opening with a 25 gauge needle at a location where the detached posterior hyaloid membrane was farthest from the retinal surface. The location was selected based on six preoperative meridional OCT scans. The posterior hyaloid was then gently peeled off in a circular fashion around the fovea with a micropick. Visual acuity and foveal thicknesses were measured before the operation and 3 months afterwards. RESULTS: After the operation, visual acuity improved and central macular thicknesses were reduced significantly in all six patients. The best corrected visual acuity improved from 0.4 to 0.75 with a mean increase by 3.5 lines on a Snellen chart 3 months after the operation. The mean foveal thickness was reduced from 406 micrometer to 241 micrometer. The restoration of foveal pit was observed in five patients. Neither intraoperative nor postoperative complications were observed during the follow up period. CONCLUSIONS: An OCT retinal mapping program is a valuable diagnostic tool in understanding the configuration of vitreomacular adhesion and planning the surgical approach for operating on vitreomacular traction syndrome.

Diagnosis and Treatment of Vitreomacular Traction Syndrome Using Optical Coherence Tomography

PURPOSE: To determine the benefit of optical coherence tomography (OCT) in the diagnosis of vitreomacular traction syndrome and evaluate the vitreoretinal interface before and after vitreous surgery. METHODS: Medical records of five patients with vitreomacular traction syndrome who had undergone vitrectomy were reviewed. Preoperative and postoperative visual acuity and preoperative and postoperative OCT were reviewed. In all patients OCT demonstrated posterior vitreous detachment and a focal adhesion of hyaloid membrane to macula with traction on the foveal retinal tissue. All of them underwent pars plana vitrectomy with peeling of poterior hyaloid face. RESULTS: Visual acuity improved in 4 eyes after the first vitrectomy. One eye developed postoperatively a macular hole, which was treated with the second vitrectomy and intravitreal gas tamponade with subsequent improvement in vision. In 4 eyes, OCT showed elimination of vitreous strand, relief of vitreous traction and restoration of normal foveal contour after vitrectomy. CONCLUSION: Optical coherence tomography is a useful tool in the diagnosis of vitreomacular traction syndrome and in the evaluation of status of vitreoretinal interface before and after vitrectomy. Following pars plana vitrectomy, vision improved and normal foveal contour was restored.