Vitreomacular adhesion and neovascular age-related macular degeneration

Material properties of the internal limiting membrane and their significance in chromovitrectomy

Intraoperative visualization of the internal limiting membrane (ILM), the choice of a point of vantage for lifting an initial flap, the precision with which the ILM is grasped, adhesion between the forceps and the ILM, thickness, stiffness and elasticity of the ILM as well as monitoring of the completeness of ILM removal are all important factors for safety and efficacy of a chromovitrectomy intervention. The understanding of the underlying physical features of the ILM, such as contrast behavior and bioanatomical and biomechanical properties represent, thus, useful prerequisites for successful macular surgery. New analytical tools, such as atomic force microscopy and chromaticity analysis, allow new insights into ILM material characteristics, permitting a systematic approach to refinement of surgical technique. .

Intravitreal injection of expansile perfluoropropane (c(3)f(8)) for the treatment of vitreomacular traction

PURPOSE

To study the efficacy of a single intravitreal injection of expansile gas in releasing vitreomacular traction.

DESIGN

Retrospective, interventional case series.

METHODS

Fifteen eyes of 14 consecutive patients with symptomatic and persistent vitreomacular traction (>3 months' duration) on spectral-domain optical coherence tomography (SD OCT) received a single intravitreal injection of 0.3 mL 100% perfluoropropane (C(3)F(8)) as an alternative to pars plana vitrectomy (PPV). Primary outcome was the number of eyes with complete vitreomacular traction release on OCT 1 month following treatment. Secondary outcomes included changes in visual acuity (VA), foveal contour, central foveal thickness, and maximal foveal thickness 1 month following treatment, and final VA.

RESULTS

Mean age (± SD) was 72.1 ± 12.6 years. Mean follow-up was 398.7 ± 174.4 days. Vitreomacular traction was idiopathic in 7 eyes and associated with diabetes in 6. One month following treatment, vitreomacular traction was released in 6 eyes (40%). Three further eyes (20%) had resolution of vitreomacular traction within 6 months, 4 (27%) underwent PPV, and 2 (13%) subsequently declined surgery. Foveal contour was restored in 7 eyes (47%). VA and central foveal thickness were similar 1 month following treatment, but maximal foveal thickness decreased by 65.8 μm (P = .041). Mean final VA decreased 0.03 logMAR units from baseline (P = .536). Eyes with vitreomacular traction release within 1 month had less extensive vitreomacular traction (P = .037), low vitreous face reflectivity, and maximal foveal thickness <500 μm (P = .004) pretreatment. There were no associated adverse events.

CONCLUSIONS

Intravitreal C(3)F(8) injection could offer a minimally invasive alternative to PPV in patients with symptomatic and persistent vitreomacular traction. It appears particularly effective in eyes with less extensive vitreomacular traction and low vitreous face reflectivity on SD OCT. Further studies are warranted.