Modest visual acuity gains after PPV for vitreomacular traction may not reflect benefits

This meta-analysis on  pars plana vitrectomy (PPV) for vitreomacular traction syndrome found that visual acuity gains were relatively modest but this may not fully reflect symptomatic relief.

With the recent development of intravitreal ocriplasmin for  vitreomacular traction, this is a timely analysis. While this study demonstrates that most patients with vitreomacular traction who underwent PPV experienced improved visual acuity, the authors acknowledge that visual acuity alone is a poor predictor of successful treatment in these patients as metamorphopsia was their predominant symptom.

In 255 patients with vitreomacular traction syndrome from 17 studies, visual acuity improved from 20/94 to 20/53 after PPV. Approximately one-third of eyes gained two Snellen lines, and on average, eyes gained 0.25 logMAR or slightly less than two Snellen lines. Of 19 studies that categorized eyes into those with visual acuity that improved, worsened, or stayed the same, 9.2 percent of eyes lost visual acuity, 11.7 percent were unchanged and 64.3 percent improved.

Fifteen studies reported on complications. The most common postoperative complications were cataract (34.7 percent of 304 eyes; 63.2 percent of phakic eyes), epiretinal membrane (5.7 percent of 348 eyes) and retinal detachment (4.6 percent of 348 eyes).

The authors say that while the safety of PPV for vitreomacular traction seems acceptable, the retinal detachment rate was somewhat higher than expected.