Indications and outcomes for intravitreal injection of C3F8 gas for symptomatic vitreomacular traction

Choroidal vascularity index changes in different treatments for vitreomacular traction

INTRODUCTION

The aim of this study was to examine if choroidal vascularity index (CVI) is different in eyes with unilateral vitreomacular traction (VMT) from their healthy fellow eyes; and whether different treatments affect the CVI.

METHODS

The baseline and 8-week post treatment CVIs of 56 unilateral VMT patients that underwent spontaneous resolution (n = 30), vitreoretinal surgery (n = 16) or pneumatic vitreolysis (n = 10) were compared with fellow eyes using paired samples t-test. Partial correlation analyses correcting age and gender was used for calculations between treatment groups. P values < 0.05 were considered statistically significant.

RESULTS

The mean baseline CVI for VMT and control eyes had no statistically significant difference (p = 0.81, r= -0.38). The post traction release follow-up CVI of VMT eyes and contralateral eyes had no significant difference (p = 0.12, r = 0.49). In spontaneous resolution group, vitreoretinal surgery group and pneumatic vitreolysis group the baseline and follow up CVIs of VMT eyes were statistically similar (p = 0.72, p = 0.32 and p = 0.79 respectively).Spontaneous detachment patients' CVIs showed a 0.57±5.81% increase, vitreoretinal surgery group had a reduction of 1.098±4.76%, and the pneumatic vitreolysis patients showed a CVI reduction of 0.307±4.24%. However, none of these changes was found to be statistically significant when compared between the groups (p = 0.21, r = 0.02).

DISCUSSION

Previous studies have argued that vitreomacular traction might have a role on the choroidal changes seen in the vitreoretinal interface disorders. This study has shown that VMT alone does not cause any significant changes in choroidal vascular index pre or post traction release.

Surgical Outcome of Vitreomacular Traction Associated With Macular Hole

Vitreomacular Interface pathology and its surgical treatment is an ever-evolving field in vitreoretinal surgery. Various treatments have been proposed for macular holes associated with vitreomacular traction including ocriplasmin injection, gas injection, and pars plana vitrectomy with posterior hyaloid face stripping with or without internal limiting membrane peeling. The time of intervention in patients with vitreomacular traction syndrome is also a point of contention among researchers. Here we present a case of an 83-year-old male patient who presented to the outpatient department with a history of grossly decreased visual acuity of counting fingers in the right eye. An altered foveal reflex was seen in an otherwise unremarkable ocular examination. The left eye revealed no pertinent findings. The patient was diagnosed with vitreomacular traction syndrome on spectral domain optical coherence tomography. There was an associated grade 1b macular hole according to the International Vitreomacular Traction Study classification. As the roof of the macular hole was intact, we decided to proceed with pars plana vitrectomy and careful stripping of the posterior hyaloid face. However, this resulted in a full-thickness macular hole and no change in visual acuity. A second surgery comprising internal limiting membrane peel using brilliant blue dye with perfluoropropane (C₃F₈) gas tamponade was done. Follow-up after six weeks showed a visual acuity improvement to 20/120 and restoration of foveal configuration. To the best of our knowledge, such a clinical case has not been reported in locally published literature.

The outcomes of intravitreal C3F8 gas tamponade combined with laser photocoagulation treatment for optic disc pit maculopathy

Purpose

To share the anatomical results and visual outcomes of intravitreal gas tamponade combined with laser photocoagulation treatment for optic disc pit maculopathy (ODPM).

Methods

Intravitreal gas tamponade combined with laser photocoagulation treatment was performed on six consecutive patients with ODPM. A 0.3 mL of 100% perfluoropropane (C₃F₈) gas was injected intravitreally. The patients were then asked to maintain prone position until the C₃F₈ gas disappeared. Laser photocoagulation was performed the day after the procedure. The outcomes were determined by spectral-domain optical coherence tomography and best-corrected visual acuity (BCVA).

Results

In the present study, visual improvement and reduction in serous macular detachment were observed in 83% of the ODPM patients. Complete retinal reattachment was achieved in 66% of the ODPM patients. In one patient, no regression was observed after the repeated treatment, and pars plana vitrectomy was performed. The final BCVA improved in five eyes and unchanged in one eye. No postoperative complications were observed during the follow-up period in any patient.

Conclusions

Intravitreal C₃F₈ gas tamponade combined with laser photocoagulation procedure is an effective, minimally invasive, and cost-effective treatment method for ODPM.