Clinical Manifestation and Result of Vitrectomy of Vitreomacular Traction Syndrome

Won Il Rhim; Hyung Soo Kim; Eun Koo Lee

doi:10.3341/jkos.2008.49.9.1468

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Rhim, Kim, and Lee: Clinical Manifestation and Result of Vitrectomy of Vitreomacular Traction Syndrome

Original Article

J Korean Ophthalmol Soc 2008;49(9):1468-1474.

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.9.1468

Clinical Manifestation and Result of Vitrectomy of Vitreomacular Traction Syndrome

Won Il Rhim, M.D., Hyung Soo Kim, M.D., Eun Koo Lee, M.D.

Kong Eye Clinic, Seoul, Korea

Address reprint requests to Eun Koo Lee, M.D. Kong Eye Clinic #139 Sungnae-dong, Gangdong-gu, Seoul 134-841, Korea Tel: 82-2-480-5000, Fax: 82-2-480-5001, E-mail: euklee@chollian.net

Received 20 May 2008 Accepted 28 December 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the clinical manifestation and the result of vitrectomy in patients with vitreomacular traction syndrome.

Methods

Optical coherent tomography (OCT) was used to evaluate the clinical manifestation and the results of vitrectomy for 26 eyes with vitreomacular traction syndrome.

Results

Spontaneous relief of vitreomacular traction was achieved in 3 of 8 eyes after a mean follow-up duration of 9 months. One eye recovered visual acuity, but the other 2 eyes could not attain better visual acuity because of persistent sponge-like macular edemas. Six of 13 eyes (46%) improved by two or more lines of visual acuity after vitrectomy. The presence of simple macular cysts without sponge-like macular edemas or tractional retinal detachment seemed to be related to good results after vitrectomy.

Conclusions

Vitrectomy is a preferable way to treat vitreomacular traction syndrome. Preoperative OCT could predict the surgical prognosis.

Keywords: Optical coherent tomography, Vitrectomy, Vitreomacular traction syndrome

References

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Figure 1.

Subtypes of the vitreomacular traction according to the amount of posterior vitreous detachment. (A) Anteroposterior vitreous strand causing vitreomacular traction focusing on the macular center, a large macular cyst is shown at the fovea. (B) V-shaped posterior vitreous detachment causing pagoda-shaped foveal elevation with macular cysts. (C) Imcomplete posterior vitreous detachment with broad vitreomacular adhesion causing multiple small macular cysts and sponge-like macular edema.

Figure 2.

Various macular pathologic changes caused by vitreomacular traction syndrome. (A) V-shaped posterior vitreous detachment and epiretinal membrane causing pagoda-shaped foveal elevation. (B) Dome-shaped macular elevation showing sponge-like macular edema by the broad vitreomacular adhesion. (C) Vitreomacular traction syndrome with the formation of a macular hole. (D) Severe tractional retinal detachment with the accumulation of subretinal fluid and small macular cysts in the inner retinal layer.

Table 1.

Incidence and mean initial visual acuity of subtypes of vitreomacular traction syndrome associated with macular pathologic changes by optical coherent tomography

Types of VMT∗	Associated macular pathology (n, mean initial visual acuity)
Types of VMT∗	Absent	Macular cyst	Macular cyst & TRD^†	Macular cyst & MH^‡	SME^§	SME & TRD	TRD	Total
Anteroposteior strand	1 (0.6)	2 (0.65)				1 (FC^∏)	1 (0.50)	5 (0.48)
V-shaped PVD^#		3 (0.37)				2 (0.20)	3 (0.17)	8 (0.25)
Broad macular attachment		3 (0.43)	3 (0.28)	1 (0.15)	3 (0.20)	3 (0.23)		13 (0.28)
Total	1 (0.6)	8 (0.46)	3 (0.28)	1 (0.15)	3 (0.20)	6 (0.18)	4 (0.25)	26 (0.31)

^∗ Vitreomacular traction

^† Tractional retinal detachment

^‡ Macular hole

^§ Sponge-like macular edema

^∏ Finger count

^# Posterior vitreous detachment

Table 2.

Progression of vitreomacular traction and change of visual acuity in vitreomacular traction syndrome after follow-up period without vitrectomy

Types of progression of VMT∗	n (%)	Mean FU^† duration (months)	Visual acuity
Types of progression of VMT∗	n (%)	Mean FU^† duration (months)	Initial	Final
No significant change	4 (50.0)	11.0	0.35	0.33
Spontaneous relief of VMT	3 (37.5)	9.0	0.37	0.43
Aggravated CME^‡	1 (12.5)	20	0.7	0.5
Total	8	11.4	0.40	0.38

^∗ Vitreomacular traction

^† Follow-up

^‡ Cystoid macular edema.

Table 3.

Results of vitrectomy for the treatment of vitreomacular traction syndrome

	n (%)	Mean visual acuity
	n (%)	Preoperative	Postoperative
Postoperative visual acuity
Improved ≥ 2 lines	6 (46)	0.27	0.72
Stable	4 (31)	0.20	0.24
Decreased	3 (23)	0.23	0.13
Postoperative OCT∗ findings
Normal	5 (46)	0.33	0.80
Persistent CME^†	2 (15)	0.18	0.20
Persistent sponge-like swelling	5 (31)	0.20	0.24
Full-thickness MH^‡	1 (8)	0.1	HM§
Total	13	0.24	0.43

^∗ Optical coherent tomography

^† Cystoid macular edema

^‡ Macular hole

^§ Hand movement.

Table 4.

Result of vitrectomy according to the subgroups of vitreomacular traction syndrome

Types of VMT∗	Associated macular pathology (n, mean visual acuity - preoperative/postoperative)						Total^#
Types of VMT∗	Macular cyst	Macular cyst & MH^†	Macular cyst & TRD^‡	SME§	SME & TRD	TRD	Total^#
Anteroposteior strand						1 (0.5/0.9)		1 (0.5/0.9)
V-shaped PVD^∏	1 (0.2/0.8)				1 (0.3/0.15)	1 (0.15/0.2)		3 (0.22/0.38)
Broad macular attachment	2 (0.40/0.65)	1 (0.15/1.0)	1 (0.2/0.2)	3 (0.20/0.22)	2 (0.10/0.23)		9 (0.22/0.40)
Total^#	3 (0.33/0.70)	1 (0.15/1.0)	1 (0.2/0.2)	3 (0.20/0.22)	3 (0.17/0.20)	2 (0.33/0.50)		13 (0.24/0.43)

^∗ Vitreomacular traction

^† Macular hole

^‡ Tractional retinal detachment

^§ Sponge-like macular edema

^∏ Posterior vitreous detachment

^# ^# Number of cases, mean initial visual acuity/mean final visual acuity.

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