Spontaneous Resolution of Vitreomacular Traction Associated with Diabetic Macular Edema

NATURAL COURSE OF VITREOMACULAR TRACTION IN EYES WITH DIABETIC RETINOPATHY AND FACTORS ASSOCIATED WITH SPONTANEOUS RELEASE

PURPOSE

The aim of this study was to determine the natural course of vitreomacular traction (VMT) in patients with diabetic retinopathy and to evaluate the factors associated with VMT relief.

METHODS

Seventy-four eyes of 65 patients with VMT accompanying diabetic retinopathy were evaluated retrospectively. The presence of intravitreal injection and the presence of panretinal photocoagulation were obtained from the medical records of the patients. Spontaneous release of VMT, the horizontal length of vitreomacular traction, the presence of hyperreflective retinal spots, the presence of the epiretinal membrane, and the grade of VMT were evaluated from the spectral-domain optical coherence tomography images. Factors associated with the spontaneous release of VMT were evaluated by logistic regression analysis.

RESULTS

Spontaneous release was observed in 28 eyes (37.8%). The horizontal length of VMT was lower in the release of the VMT group compared with the persistent VMT group (P = 0.03). The persistent VMT group had a higher rate of hyperreflective retinal spots and epiretinal membrane compared with the release of the VMT group (respectively; P = 0.003 and P = 0.031). No statistically significant difference was observed between the release of VMT and persistent VMT groups in terms of intravitreal injection and panretinal photocoagulation treatment (respectively; P = 0.938 and P = 0.36). The absence of hyperreflective retinal spots was the most important prognostic factor for the spontaneous release of VMT (P = 0.029).

CONCLUSION

Spontaneous release of VMT observed higher rates of patients without hyperreflective retinal spots, epiretinal membrane, and patients with lower horizontal length of VMT.

PNEUMATIC VITREOLYSIS FOR RELIEF OF VITREOMACULAR TRACTION

Pneumatic vitreolysis with C₃F₈ gas is effective in releasing focal vitreomacular traction in a high percentage of eyes with few adverse events, especially with limited vitreomacular traction (within 1 disk area), lack of thick cellophane membranes, no diabetes mellitus, younger age (mean age of 69.1 years vs. 78.1 years), better baseline best spectacle–corrected visual acuity (mean of 20/50 vs. 20/66), small Stage 2 macular hole, and female gender.

Purpose:

To evaluate the outcome of perfluoropropane (C₃F₈) gas injection for symptomatic vitreomacular traction (VMT) with or without Stage 2 macular hole (MH).

Methods:

A retrospective review of eyes with VMT treated with 0.3 mL of C₃F₈ gas was performed. Patients avoided the supine position until gas resolution. Patients with small MH maintained partial face-down positioning.

Results:

Forty-nine consecutive patients (50 eyes) with symptomatic VMT underwent pneumatic vitreolysis between 2010 and 2016. A posterior vitreous detachment developed in 43 eyes (86.0%) after a single gas injection, at a median of 3.0 weeks. Twenty-eight of 35 eyes (80.0%) with VMT only and all 15 eyes (100%) with a small Stage 2 MH developed a posterior vitreous detachment, with MH closure in 10 of 15 eyes (66.7%). Median baseline and last best spectacle–corrected visual acuities were 20/50 and 20/40, respectively (P < 0.001). Mean follow-up time was 11.1 ± 9.9 months. Rate of posterior vitreous detachment was reduced with presence of diabetes mellitus (25%) and with thick cellophane membrane (50%). Univariate analysis showed increased VMT release for eyes with VMT extent within 1 disk area (χ² = 13.1, P = 0.002), eyes with absence of diabetes mellitus (χ² = 8.8, P = 0.007), and eyes with Stage 2 MH (χ² = 5.47, P = 0.019); there was a trend between success and lack of thick cellophane membrane (χ² = 3.32, P = 0.068). Results using logistic regression also showed younger age (P = 0.012), followed by better baseline best spectacle–corrected visual acuity (P = 0.044), lack of diabetes mellitus (P = 0.077), and female gender (P = 0.045) to be predictors of increased VMT release. One VMT-only eye formed a MH and another VMT-only eye developed a retinal detachment. Both eyes responded to vitrectomy.

Conclusion:

Pneumatic vitreolysis with limited face-down position is a viable option for treating VMT with few adverse events. More studies are needed to elucidate its indications, benefits, and risks.

Spontaneous Resolution of Vitreomacular Traction following Ranibizumab (Lucentis) Injection

Purpose

Spontaneous resolution of vitreomacular traction syndrome in diabetic patients is a rare phenomenon that has been poorly described in the literature.

Methods

Case presentation.

Results

The authors present a case of spontaneous resolution of vitreomacular traction following intravitreal administration of ranibizumab.

Conclusions

In patients with vitreomacular traction syndrome and diabetic macular edema, the combination of the possible vitreous liquefaction and mechanical increase of vitreous volume caused by an intravitreal injection with a degree of reduction in retinal thickness caused by the effect of vascular endothelial growth factor inhibition could play a role in the resolution of vitreomacular traction.

Spontaneous resolution of vitreomacular traction syndrome in a patient with diabetes with associated thickened posterior hyaloid prior to elective parsplanar vitrectomy demonstrated on optical coherence tomography

To describe an unusual case of vitreomacular traction syndrome spontaneously resolving prior to elective pars planar vitrectomy demonstrated on optical coherence tomography.

Optical Coherence Tomography Use in Evaluation of the Vitreoretinal Interface: A Review

Optical coherence tomography (OCT) is a valuable tool for assessment of the vitreoretinal interface. This article reviews the normal process of age-related posterior vitreous detachment as viewed by OCT. Abnormalities of the vitreoretinal interface as imaged by OCT are described including vitreomacular traction syndrome, cystoid macular edema/ diabetic macular edema, epiretinal membranes, full thickness macular holes, lamellar holes, pseudoholes, microholes, and schisis from myopia or optic pits/colobomas. This tool has given us new insights into the pathogenesis of these retinal abnormalities.