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  • Initial Observation for Idiopathic Vitreomacular Traction

    By Jean Shaw
    Selected by Andrew P. Schachat, MD
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    Journal Highlights

    Ophthalmology Retina, October 2022

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    Patel et al. reviewed the clinical course and outcomes of patients with idio­pathic vitreomacular traction (VMT) who are managed initially by observa­tion. They found that VMT follows a generally stable clinical course when managed in this manner. Stable VMT grade was the most frequent outcome, and eyes with grade 1 VMT were more likely to undergo spontaneous release than were eyes with grade 2 or 3.

    For this retrospective chart review, the researchers assessed the outcomes of 317 patients (436 eyes) who were evaluated between Jan. 1, 2015, and Feb. 15, 2021. Patients’ mean age was 72.2 ± 8.9 years at the initial visit, and the mean follow-up time was 34 ± 19.2 months. The authors ascribed VMT severity grade to each patient using previously published grading criteria. The main outcome measures were the rate of spontaneous release, grade at baseline compared with grade at final follow-up, and outcomes of any inter­ventions performed.

    At baseline, the patients’ mean BCVA was 20/40. Baseline OCT demonstrated grade 1 VMT in 212 eyes (48.6%), grade 2 in 172 (39.4%), and grade 3 in 52 (11.9%). Outcomes by grade were as follows:

    • Eyes initially grade 1. Of these eyes, 25% had spontaneous release of VMT (median, 290 days), 50.9% remained stable, and 10.4% worsened.
    • Eyes initially grade 2. Of these eyes, 14.5% had spontaneous release of VMT (median, 570 days), 55.2% remained stable, 4.7% improved, and 2.3% wors­ened.
    • Eyes initially grade 3. Of these eyes, 5.8% had spontaneous release of VMT (median, 790 days), 28.8% remained stable, and 5.8% improved.

    All told, development of macular holes occurred in 42 (9.6%) of the 436 eyes. Pars plana vitrectomy (PPV) was performed in 94 eyes (21.6%). The mean BCVA in these treated eyes was 20/78 prior to PPV and 20/55 at final follow-up.

    The original article can be found here.