Transient Vitreomacular Traction Syndrome caused by Traumatic Incomplete Posterior Vitreous Detachment

To study the efficacy of pneumatic induction of posterior vitreous detachment for the treatment of vitreomacular traction syndrome, the analysis of the results of surgical treatment of 10 patients (10 eyes) with vitreomacular traction syndrome was performed, among them 8 patients (8 eyes) had an accompanied immature age-related cataract and 2 patients (2 eyes) - pseudophakia. The average age of the patients was 64.1±4.6 years, among them 8 women and 2 men. The mean best corrected visual acuity on admission was 0.31±0.15, the average length of vitreomacular adhesion and retina thickness in the fovea by optical coherence tomography were 289.3±75.4 and 367.5±50.3 μm, respectively. Patients with pseudophakia underwent pneumatic induction of the posterior vitreous detachment, and patients with cataract underwent the same surgery in combination with phacoemulsification of the cataract and intraocular lens implantation. Within 1 month of follow-up, all patients had a complete posterior vitreous detachment and increased best corrected visual acuity. Intraocular pressure remained normal throughout the follow-up period in 9 out of 10 patients, 1 patient experienced hypertension on day 1 after the surgery, which required decompression during the gas expansion period. Further on, intraocular pressure was normalized and did not require therapy. Pneumatic induction of posterior vitreous detachment is an effective method of treatment of vitreomacular traction syndrome, which allows eliminating vitreomacular traction; the combination of pneumatic induction of the posterior vitreous detachment with phacoemulsification of cataract allows avoiding hypertension during and after operation and avoiding performing vitrectomy.

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

Scientific Reports ◽

10.1038/s41598-021-97639-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Josef Guber ◽

Celine Rusch ◽

Ivo Guber ◽

Hendrik P. N. Scholl ◽

Christophe Valmaggia

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Adverse Events ◽

Gas Injection ◽

Posterior Vitreous Detachment ◽

Vitreomacular Traction ◽

Final Visit ◽

Viable Option ◽

Vitreous Detachment ◽

Lower Success Rate

AbstractTo evaluate the indications and outcomes of perfluoropropane (C3F8) gas injection for symptomatic vitreomacular traction (VMT). A retrospective analysis of eyes with VMT treated with 0.3 mL of C3F8 gas was performed. Patients were not asked to posture after gas injection. In phakic patients, cataract surgery was performed simultaneously. Patients were examined after one week and one month postoperatively. Twenty-nine consecutive eyes of 26 patients with symptomatic VMT who underwent pneumatic vitreolysis were included. A complete posterior vitreous detachment was achieved in 18 eyes (62.1%) after a single gas injection at the final visit. The rate of posterior vitreous detachment was reduced significantly with the presence of epiretinal membrane (ERM) (p = 0.003). Three eyes formed a macular hole (MH) postoperatively and another eye developed a retinal detachment. Mean visual acuity increased significantly after one month (p < 0.008). Pneumatic vitreolysis is a viable option for treating VMT with few adverse events. Patient with concomitant ERM had a significantly lower success rate.

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Diagnosing and Treating Vitreomacular Adhesion

European Ophthalmic Review ◽

10.17925/eor.2011.05.01.69 ◽

2011 ◽

Vol 05 (01) ◽

pp. 69 ◽

Cited By ~ 4

Author(s):

Paolo Carpineto ◽

Luca Di Antonio ◽

Agbeanda Aharrh-Gnama ◽

Vincenzo Ciciarelli ◽

Leonardo Mastropasqua ◽

...

Keyword(s):

Posterior Vitreous Detachment ◽

Standard Of Care ◽

Age Related Macular Degeneration ◽

Vitreomacular Traction ◽

Vitreous Surgery ◽

Vitreomacular Adhesion ◽

Current Standard ◽

Vitreous Detachment ◽

Age Related ◽

23 Gauge

Perifoveal vitreous detachment with residual vitreofoveal adhesion is considered as the first stage of posterior vitreous detachment. A key point is the transition from an innocuous vitreomacular adhesion (VMA) to a pathological vitreomacular traction (VMT). By using optical coherence tomography (OCT), VMA is defined as adhesion of the posterior hyaloid cortex involving the centre of the foveal region with or without a hyper-reflective signal on the inner surface of the retina. VMT is diagnosed when the inner macular surface slopes steeply, or sharp angulation and localised deformation of the retinal profile is detected at the VMA site. Otherwise, VMA is simply considered to be persistent adherence of the cortical vitreous. The tractional effects of perifoveal vitreous detachment cause a variety of macular pathologies determined by the size and the strength of the residual vitreoretinal adhesion. Vitreomacular adhesion plays a major role in the development of diseases such as vitreomacular traction syndrome (VMTS), macular hole, epiretinal membrane, tractional macular oedema and myopic macular retinoschisis. In addition, clinical evidence supports the theory that the course of diabetic retinopathy and age-related macular degeneration may be strongly influenced by an incomplete posterior vitreous separation. The current standard of care of vitreomacular interface pathologies is vitrectomy and membrane peeling a procedure that is thought to relieve epiretinal traction followed by regeneration of the retinal architecture and recovery of visual function. Over the last few years, with the introduction of 25-gauge (0.50mm) and 23-gauge (0.72mm) instruments, there has been another major shift toward transconjunctival microincisional vitrectomy surgery (MIVS). Pharmacological induction of posterior vitreous detachment (PVD) can become a further step toward a real minimally invasive vitreous surgery for VMTS.

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Vitrectomy in the Management of Vitreomacular Traction Syndrome

Journal of VitreoRetinal Diseases ◽

10.1177/2474126417749321 ◽

2018 ◽

Vol 2 (2) ◽

pp. 91-95

Author(s):

Zofia Michalewska ◽

Jerzy Nawrocki

Keyword(s):

Visual Acuity ◽

Visual Outcome ◽

Internal Limiting Membrane ◽

Long Term Results ◽

Vitreomacular Traction ◽

Study Group ◽

Vitreous Detachment ◽

Vitreomacular Traction Syndrome ◽

The Mean ◽

Final Visual Outcome

Purpose: To estimate long-term results after vitrectomy with internal limiting membrane peeling in vitreomacular traction syndrome (VMTS), as well as to estimate factors influencing final visual outcome. Methods: Medical records of all patients who underwent pars plana vitrectomy for idiopathic VMTS from 2007 through 2015 were assessed. Spectral domain optical coherence tomography was performed preoperatively and at least 6 months after surgery. The mean horizontal and vertical diameters of the vitreomacular traction (VMT) were measured. The area of vitreomacular attachment was calculated. Results: Twenty-four eyes of 22 patients (mean age, 74 years) were included in this study. Mean visual acuity improved significantly from 0.26 Snellen (0.69 logMAR) to 0.39 Snellen (0.43 logMAR) in the mean of 29 months after surgery (7-90 months; median, 25 months; P = .02, paired t test). Visual acuity improved in 18 eyes, remained unchanged in 2 cases, and decreased postoperatively in 4 eyes. Multiple regression analysis did not reveal any factors significant for determining final visual acuity. However, when regrouping the patients according to the International Vitreomacular Traction Study Group, we observed that final visual acuities were statistically significantly better in eyes with focal vitreous detachment compared to broad vitreous detachment ( P = .04). Conclusions: Despite the fact that VMT is a 3-dimensional disease, the calculated area of attachment was not greater than the vertical diameter of attachment. According to the current study, the classification of VMT proposed by the VMT Study Group might be an important tool in predicting the final visual outcome after vitrectomy.

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Treatment of Vitreomacular Traction with Intravitreal Injection of Perfluoropropane

Czech and Slovak Ophthalmology ◽

10.31348/2019/4/2 ◽

2020 ◽

Vol 75 (4) ◽

pp. 182-187

Author(s):

Miroslav Veith

Keyword(s):

Intravitreal Injection ◽

Macular Hole ◽

Retrospective Review ◽

Gas Injection ◽

Posterior Vitreous Detachment ◽

Vitreomacular Traction ◽

Outpatient Basis ◽

Vitreomacular Adhesion ◽

Vitreous Detachment

Purpose: To evaluate the effect of one intravitreal injection of expansile gas in the treatment of vitreomacular traction (VMT). Methods: A retrospective review of eyes with VMT treated with singl injection of 0,3 ml of 100% C3F8 gas was performed. The procedure was performed on an outpatient basis under topical anesthesia. Results: Twelve consecutive patient (14 eyes) with symptomatic VMT underwent pneumatic vitreolysis. Mean extend of vitreomacular adhesion was 490,5 µm (408-751). A posterior vitreous detachment developed in 13 eyes (92,9 %) after a single gas injection, in 11 eyes (84,6 %) during the first month of follow-up, in 2 eyes within two month of injection. Mean baseline and last BCVA were 0,5 (0,16-0,18) and 0,67 (0,2-1,0) respectively (p < 0,001). Mean folow-up time was 5,8 (1-16) months. The procedure was also successful in two eyes, which where previously unsuccessfuly treated with ocriplasmin. One eye formed a macular hole. There were no other complication. Conclucion: Intravitreal injection of C3F8 is an effective, safe and inexpensive therapy of vitreomacular traction.

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Pharmacotherapy of Vitreomacular Traction

Current Pharmaceutical Design ◽

10.2174/1381612825666190124102148 ◽

2019 ◽

Vol 24 (41) ◽

pp. 4874-4881 ◽

Cited By ~ 4

Author(s):

Ran Wan ◽

Thomas Hong ◽

Yasser Tariq ◽

Andrew Chang

Keyword(s):

Paradigm Shift ◽

Posterior Vitreous Detachment ◽

Vitreomacular Traction ◽

Current Status ◽

Vitreous Detachment ◽

The Past ◽

Enzymatic Agents ◽

Vitrectomy Surgery ◽

Over Time ◽

Anomalous Posterior Vitreous Detachment

Vitreomacular traction occurs due to incomplete or anomalous posterior vitreous detachment. Over time, the vitreous pulls anteriorly and causes retinal distortion and eventually reduced vision. Traditionally, vitreomacular traction was treated with vitrectomy surgery. In the past few years, there is a paradigm shift towards pharmacologic vitreolysis, which involves the intravitreal injection of enzymatic and non-enzymatic agents that facilitate posterior vitreous detachment. Many agents have been investigated and trialled including plasmin, microplasmin (Ocriplasmin), hyaluronidase, nattokinase, chondroitinase and dispase. This review will focus on the progress and current status in this research.

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Vitreomacular Traction: Pathophysiology, Classification, Clinical Diagnosis, and Treatment

Güncel Retina Dergisi (Current Retina Journal) ◽

10.37783/crj-0101 ◽

2018 ◽

pp. 249-255

Keyword(s):

Eye Movements ◽

Clinical Diagnosis ◽

Posterior Vitreous Detachment ◽

Diagnosis And Treatment ◽

Wide Area ◽

Vitreomacular Traction ◽

Vitreomacular Adhesion ◽

Vitreous Detachment ◽

Foveal Detachment ◽

Tractional Forces

Vitreomacular adhesions between the macula and the cortex may cause complications during the normal posterior vitreous detachment. These adhesions can affect a focal or wide area. Simple vitreomacular adhesion may not alter the macular anatomy. But sometimes these tractional forces can cause vitreomacular tractions with eye movements. This situation leads to distortion of the retina and foveal detachment. This review mentions the Vitreomacular Traction in the main aspects.

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