Spontaneous Resolution of Vitreoretinal-Iinterface Disorders

Ji Won Baek; Ji Wook Yang; Young Hoon Park

doi:10.3341/jkos.2013.54.9.1379

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Baek, Yang, and Park: Spontaneous Resolution of Vitreoretinal-Iinterface Disorders

Original Article

J Korean Ophthalmol Soc 2013;54(9):1379-1385.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.9.1379

Spontaneous Resolution of Vitreoretinal-Iinterface Disorders

Ji Won Baek, MD, Ji Wook Yang, MD, Young Hoon Park, MD, PhD

Department of Ophthalmology and Visual Science, The Catholic University of Korea College of Medicine, Seoul, Korea

Address reprint requests to Young Hoon Park, MD, PhD Department of Ophthalmology, The Catholic University of Korea Seoul St. Mary’s Hospital, #222 Banpo-daero, Seocho-gu, Seoul 137-701, Korea Tel: 82-2-2258-1188, Fax: 82-2-3779-1365 E-mail: parkyh@catholic.ac.kr

∗ This study was presented as a e-poster at the 106th Annual Meeting of the Korean Ophthalmological Society 2011.

Received 17 November 201220 May 2013 Accepted 5 August 2013

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 review the mechanisms and clinical patterns of spontaneous resolution of vitreoretinal interface disorders by analyzing cases and available literature on macular hole (MH), vitreoretinal traction (VMT), and epiretinal membrane (ERM).

Methods

Medical records and optical coherence tomography (OCT) images of patients with spontaneous resolution of MH, VMT, and ERM were reviewed.

Results

Two eyes with VMT, 3 eyes with idiopathic MH, 3 eyes of traumatic MH (including 1 eye with electrical burn), and 2 eyes with ERM showed spontaneous resolution. All eyes except traumatic MH reached a visual acuity better than 0.5 af-ter resolution. All idiopathic MHs achieved anatomic closure in 6 months, and traumatic MHs in 1 month except for the electrical burn case. Seven out of 10 eyes experienced complete posterior vitreous detachment (PVD) during resolution.

Conclusions

Some cases of vitreoretinal interface disorders can resolve spontaneously with complete PVD or other mechanisms. Indicators predicting spontaneous resolution should be considered in patients with vitreoretinal interface disorder.

Keywords: Epiretinal membrane, Macular hole, Posterior vitreous detachment, Vitreoretinal interface disorder, Vitreomacular traction

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Figure 1.

Optical coherence tomography (M-OCT) of idio-pathic vitreomacular traction (VMT) with stage 1a macular hole(MH) (case 2). Initial M-OCT showed VMT with stage 1a MH and subfoveal cysts (A, B). Eight months after the first visit, M-OCT of the same patient revealed closure of macular hole with complete PVD (white arrow) and subfoveal cysts were no longer apparent (C).

Figure 2.

Optical coherence tomography (M-OCT) of idio-pathic stage 1a macular hole (MH) (case 4). Initial M-OCT showed stage 1a MH with preexisting complete posterior vit-reous detachment (white arrow at upper right) (A). Four months after the first visit, M-OCT revealed closure of MH with disrupted retinal pigment epithelium and photoreceptor inner/outer segment junction (B). Seven months after the first visit, complete closure of MH was accomplished (C).

Figure 3.

Optical coherence tomography (M-OCT) of idiopathic stage 2 eccentric macular hole (MH) (case 5). Initial M-OCT showed stage 2 eccentric MH (A). Two months after the first visit, M-OCT revealed closure of MH by retinal bridging with persis-tent subretinal fluid (B). Five months after the first visit, complete closure of MH was seen but defects at the photoreceptor in-ner/outer segment junction level remained (C). Complete PVD was observed during the process by slit-lamp funduscopic examination (not shown in the figure).

Figure 4.

Optical coherence tomography (M-OCT) of traumatic macular hole (MH) (case 6). Initial M-OCT showed MH with sub-retinal hemorrhage (white arrow) and subretinal fluid (A). One week after the trauma, M-OCT revealed marked decreased MH size with decreased subretinal fluid (B). One month after the first visit, complete closure of MH was seen but small amounts of subretinal fluid persisted with irregular hyperreflectivity at the retinal pigment epithelium and photoreceptor inner/outer segment level (C).

Figure 5.

Optical coherence tomography (M-OCT)of traumatic macular hole (MH) by electrical burn (case 8). The patient visited ophthalmologic department 3 months after the trauma with gradual progression of decreased visual acuity. M-OCT at the first visit showed MH and complete posterior vitreous detachment (white arrow) (A). One month after the first visit, M-OCT revealed de-creased MH size with decreased subretinal fluid (B). Five months after the first visit, complete closure of MH was seen but defect of photoreceptor inner/outer segment junction persisted (C).

Figure 6.

Optical coherence tomography (M-OCT)of epiretinal membrane (ERM) with pseudohole (case 9). Initial M-OCT showed ERM with pseudohole and incomplete posterior vitreous detachment (PVD) (A). One month after the first visit, M-OCT revealed resolution of ERM with complete PVD, decreased size of pseudohole and intraretinal fluid (B). Nine months after the first visit, in-traretinal fluid further decreased but still persisted (C).

Table 1.

Demographics of each patient with viteromacular interface diseases

Case	Sex	Age Diagnosis	VA1*	Fd1^†	Initial OCT	PVD1^‡	^‡ Follow-up OCT	VA2^§	Final OCT	PVD2^∏	Days^＃
1	F	75 Idiopathic VMT	0.6	VMT c ME	VMT c ME, IRF	-	PVD(+), ME c IRF	0.8	Flat	+	232
2	F	65 Idiopathic VMT c MH	0.63	VMT c MH	VMT Stage 1a MH c	-	PVD(+), ME c IRF	0.8	Flat	+	240
3	M	58 Idiopathic MH	0.13	1/4DD MH	Stage 2 MH, central	-	Retinal bridging	0.5	Flat	+	90
4	F	64 Idiopathic MH	0.5	1/4DD MH	Stage 1a MH	+	IS/OS defect	0.8	Flat	+	224
5	F	65 Idiopathic MH	0.15	1/4DD MH	Stage 2 MH, eccentric	-	Retinal bridging, IS/OS defect	0.5	Flat	+	351
6	M	17 Traumatic MH	FC10	1/4DD MH	Stage 1b MH c SRF	+	Retinal bridging, SRF	0.02 s	Flat, IRF subretinal scar	+	26
7	M	50 Traumatic MH	0.06	Tiny MH	Stage 2 MH, central	+	Retinal bridging, SRF	0.15 s	Flat, IRF subretinal scar	+	14
8	M	49 Electric burn MH c ERM	FC30	1/4DD MH	Stage 2 MH c ERM	+	ERM, IS/OS defect	0.02	Flat	+	155
9	F	66 Idiopathic ERM c pseudo hole	0.63	ERM c MH	ERM c pseudohole	-	PVD(+), ERM(-), IRF	0.63	Minimal IRF	+	287
10	F	63 Idiopathic ERM	0.63	ERM c ME	ERM c ME	-	PVD(-), ERM	1.0	Flat	+	516

OCT = optical coherence tomography; VMT = viteromacular traction; ME = macular edema; IRF = intraretinal fluid; IS/OS = photoreceptor inner/outer segment; SRF = subretinal fluid; ERM = epiretinal membrane.

^* Visual acuity at initial visit;

^† Funduscopic findings at initial visit;

^‡ Existance of complete posterior vitreous detachment at initial visit;

^§ Visual acuity at final visit;

^∏ Existance of complete PVD at final visit;

^＃ Duration of the disorder in days.

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