Comparing Pars Plana Vitrectomy and Observation for Vitreomacular Traction Syndrome

Introduction Vitreomacular traction (VMT) syndrome is an idiopathic abnormality of the vitreoretinal interface in which persistent adhesions exist between the vitreous and the retina in the setting of a partial posterior vitreous detachment (PVD). As the vitreous liquefies due to age, vitreous detaches from the macula in normal eyes. However, in some people, it continues to pull on areas of the macula as the vitreous detaches peripherally, which may cause cystoid changes in the neurosensory retina (1,2). Additionally, vitreoretinal adhesions transmit tractional forces to the retina from the vitreous body. In addition, the traction itself may induce various changes in macula such as macular surface wrinkling, tractional cystoid macular edema, chronic cystoid macular changes, retinoschisis, foveal cavitation, tractional macular detachment, and macular holes (1-5). VMT is characterized by some clinical symptoms such as metamorphopsia, photopsia, micropsia, and decreased visual acuity (VA) (1,2). Diagnosis of VMT may be challenging by biomicroscopy, especially when the area of vitreoretinal attachment is wide. Recently, optical coherence tomography (OCT) has become the most useful decisive tool in diagnosing and determining the extent of VMT and thus directing the treatment towards it2, 3. Based on the results of several studies regarding the OCT examination, the prevalence of VMT was (2.3 ± 0.2%) per eye or (2.4 ± 0.3%) per subject. Further, it was higher in older population compared to the young, associated with age, and was significantly more common in postmenopausal women (2,6,7). Recently, the international vitreomacular traction study (IVTS) group convened to support an OCT-based Abstract Objectives: This study aimed to estimate the natural course of vitreomacular traction (VMT) disorder during a 6-month follow-up using the high-resolution spectral-domain optical coherence tomography (SD-OCT). In addition, it attempted to evaluate the visual and anatomical outcomes of the patients who underwent a follow-up or vitrectomy for VMT syndrome. Materials and Methods: In this prospective study, 45 eyes from 45 patients with VMT syndrome underwent SD-OCT imaging and eye examinations. All the patients were observed for the 6 subsequent months. Further, those patients who demonstrated no spontaneous resolution of adhesion during this period underwent 3 port standard pars plana vitrectomy. Two patients were excluded from the study, then all the remaining patients were observed for 12 months. The mean observation period of all the patients was 18 months. Changes in visual acuity (VA) before and after the study were compared between the 2 groups. Results: The mean age of patients was 64.21 ± 7.712 years (51-80 years). After 6 months follow-up, 20 patients (44.45 %) represented the spontaneous release of VTM. Furthermore, mean LogMAR VA improved from 0.7042 ± 0.21 (Snellen’s equivalent of 20/100) to 0.585 ± 78 (Snellen’s equivalent of 20/76). Baseline VA was greater than or equal to LogMAR VA of 0.7 (Snellen’s equivalent of 20/100) in most of the patients who revealed a spontaneous resolution of VMT after a sixmonth follow-up. Moreover, all the patients with spontaneous release of VMT, indicated improvement in VA compared to the baseline, from mean baseline LogMAR VA of 0.5650 (Snellen’s equivalent of 20/73) to 0.4700 (Snellen’s 20/59). Finally, the mean baseline LogMAR VA improved from 0.8435 (Snellen’s equivalent 20/138) to 0.7000 (Snellen’s equivalent 20/100) in vitrectomy group. Conclusions: Approximately 44.5% of the patients demonstrated the spontaneous resolution of vitreoretinal adhesion during the 6-month follow-up. The greater was the initial VA, the higher became the spontaneous separation rate, and eventually a better visual outcome.