Factors Associated With Spontaneous Release of Vitreomacular Traction

Almeida, David R.P.; Chin, Eric K.; Rahim, Karim; Folk, James C.; Russell, Stephen R.

doi:10.1097/iae.0000000000000346

Cited by 33 publications

(33 citation statements)

References 12 publications

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“…Observation of VMT may lead to spontaneous separation in 17-34% of eyes, but conversely some may progress to MH, and prolonged disease may result in loss of vision (Almeida et al 2015;Zhang et al 2015). Observation of VMT may lead to spontaneous separation in 17-34% of eyes, but conversely some may progress to MH, and prolonged disease may result in loss of vision (Almeida et al 2015;Zhang et al 2015).…”

Section: Discussionmentioning

confidence: 99%

“…The management of symptomatic VMA does not currently have a gold standard, with options including observation, intravitreal gas, ocriplasmin and PPV. Observation of VMT may lead to spontaneous separation in 17-34% of eyes, but conversely some may progress to MH, and prolonged disease may result in loss of vision (Almeida et al 2015;Zhang et al 2015).…”

Section: Discussionmentioning

confidence: 99%

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Intravitreal gas for symptomatic vitreomacular adhesion: a synthesis of the literature

Neffendorf

Simpson

Steel

et al. 2017

Acta Ophthalmologica

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Symptomatic vitreomacular adhesion (sVMA) is defined as visual loss secondary to foveal damage from vitreomacular traction (VMT) and includes isolated VMT, impending macular hole (MH), and full-thickness MH with persisting vitreous attachment. Management options include pars plana vitrectomy (PPV), intravitreal ocriplasmin, intravitreal gas injection or observation. This synthesis of the literature aimed to assess the safety and efficacy of intravitreal gas for sVMA. Articles describing patients with VMT or MH treated with intravitreal expansile gas were selected by systematic literature review using MEDLINE, EMBASE, and the Cochrane Database of Controlled Trials (CENTRAL) up to September 2016. The main outcomes at 1 month and final review were logarithm of the minimum angle of resolution (logMAR) visual acuity (VA), anatomical success (absence of both VMT and MH, without PPV) and adverse events (AEs). The intended comparator was observation. Nine of 106 identified articles were eligible, and none were randomized controlled trials. The mean VA of 91 eyes improved from 0.55 (Snellen equivalent 6/21) to 0.48 (6/18) logMAR at 1 month and to 0.35 (6/13) logMAR at final review. The mean VA at final review, prior to a vitrectomy, was 0.42 (6/16). Anatomic success was 48% at 1 month and 57% at final review. The reported AEs comprised retinal detachment in two highly myopic eyes. Intravitreal gas injection can relieve sVMA. Larger controlled studies are needed to determine safety and efficacy relative to observation, ocriplasmin, or vitrectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Intravitreal gas for symptomatic vitreomacular adhesion: a synthesis of the literature

Neffendorf

Simpson

Steel

et al. 2017

Acta Ophthalmologica

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“…As implied by previous reports [3,12,[14][15][16][17][18][19][20][21], VMA can be complicated by a variety of defined visual dysfunction retinal diseases. The present results support the hypothesis that the incidence of defined retinal complications among VMA eyes seems to be significantly greater than that among vitreomacular separation eyes (Tables 1, 2 and 3; Figs.…”

Section: Vma Related Vision-threatening Retinal Sequelae Proved By Sdmentioning

confidence: 66%

OCT proves that vitreomacular adhesion is significantly more likely to develop vision-threatening retinal complications than vitreomacular separation

et al. 2020

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Background: SD-OCT is becoming commonplace in everyday practice. Vitreomacular adhesions (VMAs) are being more routinely diagnosed. Predictive studies to the natural course of VMA are thus clinically significant. Spectral domain-optical coherence tomography (SD-OCT) was presently utilized to analyze the incidence of floaters, the complete vitreomacular separation or VMA, the VMA complication, the vitreomacular angle (VMAng), and the complication mechanism. Methods: Monthly SD-OCT was performed on patients with/without symptomatic floaters. OCT allowed VMA and vitreomacular separation to be compared. The incidence was assessed applying one-tailed Fisher's exact tests. The VMAngs between the inner retina and posterior hyaloid were measured, and the complication mechanism was studied using OCT image. For macular hole (MH), pre-and/or post-operative best corrected visual acuities (BCVAs; LogMAR), refractions and photoreceptor conditions were also evaluated. Results: Totally, 124 eyes were included; there were 116 eyes with VMA and 8 eyes with vitreomacular separation. Considering the percentages over 124 eyes, floaters were present in 14.5% of enrolled eyes (=18/124), consisting of 12.9% of eyes with VMA (16/124) and 1.6% of eyes with vitreomacular separation (2/124). Moreover, there were twelve eyes (9.7%) with VMA-associated vision-threatening complications, including MH (n = 8; 6.5%), retinal detachment (RD; n = 2; 1.6%), vitreomacular traction (VMT; n = 1; 0.8%) and macular pucker (MP; n = 1; 0.8%). Eyes with initial VMA had a significantly greater possibility of complications than eyes with initial vitreomacular separation (p = 0.03). Among these eyes with MH (n = 8), the pre-operative BCVA (LogMAR) was 1.1 ± 0.5, which was insignificantly (p = 0.35) improved to 0.8 ± 0.7 post-operatively. The VMAng of VMA eyes with MHs was 24.2 ± 24.9°( n = 8). The critical VMAng was 13.3°. (Continued on next page)Conclusions: A minority of eyes with VMA or vitreomacular separation had floaters. Moreover, the use of SD-OCT could identify vision-threatening sequelae, namely MH, RD, MP and VMT, and this was significantly more frequent in eyes with VMA than in eyes with complete vitreomacular separation. Therefore, SD-OCT might be a useful way of identifying either identity, and evaluating VMA-associated complications. Whether VMA eyes with MH (n = 8) that have a VMAng greater than critical VMAng have a greater likelihood of tangential traction and subsequent MH needs further investigation.

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“…4,21 Width has been demonstrated as predictive of treatment outcome with intravitreal ocriplasmin 9 and shown to be prognostic of spontaneous release. 22,23 This feature of VMA exists as a continuum rather than a discrete value, 4,16 and we therefore determined that it should be measured. The longest continuous length of adhesion is likely to be the most important in terms of release rather than the sum of discontinuous areas of focal VMT, and therefore this was chosen for the classification.…”

Section: Figure 1 Schematic Representation Of the Focal Vmt Classificmentioning

confidence: 99%

The design and validation of an optical coherence tomography-based classification system for focal vitreomacular traction

Steel

Downey

Greiner

et al. 2016

Eye

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Factors Associated With Spontaneous Release of Vitreomacular Traction

Abstract: Eyes with VMT and isolated inner retinal distortion and those receiving vitreous injections are more likely to develop VMT release without the need for surgical intervention or ocriplasmin treatment.

Cited by 33 publications

References 12 publications

Intravitreal gas for symptomatic vitreomacular adhesion: a synthesis of the literature

Intravitreal gas for symptomatic vitreomacular adhesion: a synthesis of the literature

OCT proves that vitreomacular adhesion is significantly more likely to develop vision-threatening retinal complications than vitreomacular separation

The design and validation of an optical coherence tomography-based classification system for focal vitreomacular traction

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