The efficacy and safety of ocriplasmin for patients with vitreous macular traction.

PURPOSE: To estimate the efficacy and safety of ocriplasmin for patients with vitreous macular traction (VMT). METHODS: The PubMed, EMBASE and Ovid were searched up to May 2020 to identify related studies. Statistical analysis was conducted by R software version 3.6.3. Results in proportion with 95% confidence interval (CI) were calculated by means of Freeman-Tukey variant of arcsine square transformation. RESULTS: The pooling results indicated the overall complete release rate was 50% (95% CI [45%-54%]). For VMT patients younger than 65 years old, with smaller adhesion size of VMT (<1500 µm), phakic eyes, with macular hole (MH) and subretinal fluid (SRF), while without epiretinal membrane (ERM), ocriplasmin could achieve much higher complete release rates than those under opposite conditions. The general nonsurgical closure rate of MH was 34% (95% CI [30%-37%]), and it was positively correlated with the MH size. The visual improvement rate was 45% (95% CI [32%-59%]), and it was higher for patients with VMT resolution (59%, 95% CI [41%-75%]). The secondary pars plana vitrectomy (PPV) rate for patients without MH closure or VMT resolution was about 31% (95% CI [23%-39%]). The incidence of MH progression was 10% (95% CI [4%-18%]), and other severe adverse events such as endophthalmitis, retinal detachment and retinal tear were relatively rare. CONCLUSION: Ocriplasmin is an effective, reliable and relatively safe intervention for the treatment of VMT. The most suitable candidates were patients younger than 65 years old, with smaller adhesion size (<1500 µm), phakic eyes, with MH and SRF, while without ERM.

Association of Aberrant Posterior Vitreous Detachment and Pathologic Tractional Forces With Myopic Macular Degeneration.

Purpose: The purpose of this study was to assess whether the tractional elements of pathologic myopia (PM; e.g. myopic traction maculopathy [MTM], posterior staphyloma [PS], and aberrant posterior vitreous detachment [PVD]) are associated with myopic macular degeneration (MMD) independent of age and axial length, among highly myopic (HM) eyes. Methods: One hundred twenty-nine individuals with 239 HM eyes from the Myopic and Pathologic Eyes in Singapore (MyoPES) cohort underwent ocular biometry, fundus photography, swept-source optical coherence tomography, and ocular B-scan ultrasound. Images were analyzed for PVD grade, and presence of MTM, PS, and MMD. The χ² test was done to determine the difference in prevalence of MMD between eyes with and without PVD, PS, and MTM. Multivariate probit regression analyses were performed to ascertain the relationship between the potential predictors (PVD, PS, and MTM) and outcome variable (MMD), after accounting for possible confounders (e.g. age and axial length). Marginal effects were reported. Results: Controlling for potential confounders, eyes with MTM have a 29.92 percentage point higher likelihood of having MMD (P = 0.003), and eyes with PS have a 25.72 percentage point higher likelihood of having MMD (P = 0.002). The likelihood of MMD increases by 10.61 percentage points per 1 mm increase in axial length (P < 0.001). Subanalysis revealed that eyes with incomplete PVD have a 22.54 percentage point higher likelihood of having MMD than eyes with early PVD (P = 0.04). Conclusions: Our study demonstrated an association between tractional (MTM, PS, and persistently incomplete PVD) and degenerative elements of PM independent of age and axial length. These data provide further insights into the pathogenesis of MMD.

Vitreous Structure and Visual Function in Myopic Vitreopathy Causing Vision-Degrading Myodesopsia.

PURPOSE: Myopic vitreopathy features precocious fibrous vitreous liquefaction and early posterior vitreous detachment (PVD). It is unclear whether visual function is affected by myopic vitreopathy and PVD. This study assessed the relationships among axial length, structural vitreous density, PVD, and visual function. DESIGN: Retrospective case-control study. METHODS: Ultrasonography measurements were made of axial length, logMAR VA, contrast sensitivity function (CSF [Freiburg acuity contrast test]), and quantitative B-scan ultrasonography. RESULTS: Seventy-nine subjects (45 men and 34 women; mean age: 49 ± 14 years) were analyzed. Axial lengths ranged from 22 to 29.2 mm (mean: 24.9 ± 1.8 mm; myopic eyes: 26.35 ± 1.35 mm; and nonmyopic eyes: 23.45 ± 0.75 mm; P < .001). With increasing axial length there was greater vitreous echodensity (R: 0.573; P < .01) and degradation in CSF (R: 0.611; P < .01). Subgroup analyses found that myopic eyes (>- 3 diopters) had 37% more vitreous echodensity than nonmyopic eyes (762 ± 198 arbitrary units [AU] vs. 557 ± 171 AU, respectively; P < .001) and that CSF was 53% worse in myopic eyes (3.30 ± 1.24 Weber index [%W]) than in nonmyopic eyes (2.16 ± .59 %W; P < .001). Myopic eyes with PVD had 33% greater vitreous echodensity (815 ± 217 AU; P < .001) and 62% degradation in CSF (3.63 ± 2.99 %W) compared to nonmyopic eyes with PVD (613 ± 159 AU; 2.24 ± 0.69 %W; P < .001, each). Limited vitrectomy was performed in 11 of 40 cases (27.5%), normalizing vitreous echodensity and CSF in each case. CONCLUSIONS: Axial myopia is associated with increased fibrous vitreous liquefaction and echodensity, as well as profound degradation of CSF. PVD in myopic eyes is associated with even more structural and functional abnormalities, normalized by limited vitrectomy. These findings may explain some common complaints of myopic patients with respect to vision and quality of life.

Continued smoking and posterior vitreous adhesion in the elderly evaluated on swept-source optical coherence tomography.

In this cross-sectional study including 1150 eyes of 681 volunteers ≧ 65 years old without retinal pathology, factors affecting the progression of posterior vitreous detachment (PVD) were investigated. PVD stages were diagnosed based on swept-source optical coherence tomography (SS-OCT). Linear mixed effect model was used to determine whether age, gender, diabetes mellitus (DM), hypertension (HT), dyslipidemia (DL), and smoking status were associated with various stages of PVD. As a result, the multivariable analysis disclosed that the associations between older age and higher PVD stages (estimate [95% CI], 0.031 [0.020 to 0.042]; P < 0.0001), and current smokers and lower PVD stages (estimate [95% CI], - 0.24 [- 0.43 to - 0.056]; P = 0.011) were statistically significant. In contrast, female gender was not an independent factor affecting PVD stages in the elderly. Our analysis indicated that higher PVD stages observed in female eyes may be due to confounding effect, in which current smokers were predominantly males (i.e., 12.6% among males vs. 3.9% among females, P < 0.0001). In conclusion, our findings suggest that continuous smoking is associated with an adherent vitreoretinal interface in the elderly.

A mechanical model of posterior vitreous detachment and generation of vitreoretinal tractions.

We propose a mechanical model of generation of vitreoretinal tractions in the presence of posterior vitreous detachment (PVD). PVD is a common occurrence with aging, and it consists in the separation of the vitreous body from the retina at the back pole of the eye, due to progressive shrinking of the vitreous gel. During this separation process, vitreoretinal tractions are generated at regions of high adhesion between the vitreous and the retina. Such tractions are mainly responsible for the creation of retinal tears, which can lead to retinal detachment. We describe the PVD evolution developing a continuum model of a shrinking soft body, representing the vitreous humor gel phase. In the model, the vitreous is surrounded by a membrane, stiffer than the bulk, the vitreous cortex, and it is contained within a rigid spherical domain, the vitreous chamber. The membrane is attached to the spherical wall and the adhesion strength is spatially non-uniform, increasing from the back to the front of the chamber, according to clinical observations. During the shrinking process, the vitreous undergoes elastic distortions, owing to the spatially variable adhesion on the wall, and this produces boundary tractions. We also consider the clinically relevant case of anomalous PVD, in which regions of focal adhesion between the vitreous and the retina exist, leading to the generation of strong, localized tractions. The model reproduces a PVD evolution in good qualitative agreement with clinical observations and makes it possible to correlate the shape of the detached vitreous with the intensity of vitreoretinal tractions.

Impact of posterior vitreous detachment on contrast sensitivity in patients with multifocal intraocular lens.

PURPOSE: To investigate posterior vitreous detachment (PVD) and pars plana vitrectomy (PPV) effects on contrast sensitivity function (CSF) in patients with a multifocal intraocular lens (MfIOL). METHODS: This single-center prospective case-control study analyzed 27 patients with 43 consecutive eyes. Twenty patients with 36 consecutive eyes received MfIOL implantation with either ZLB00 or ZMB00. CSF was measured as the area under the log contrast sensitivity function (AULCSF) in the presence and absence of PVD (PVD+ group and PVD- group, respectively). Seven eyes associated with a symptomatic PVD and severe visual dissatisfaction after MfIOL implantation underwent PPV (symptomatic PVD+ group). CSF was measured prior to and after PPV. RESULTS: The mean AULCSF was significantly lower in the PVD+ group (1.5 ± 0.1) versus the PVD- group (1.7 ± 0.1, p < 0.0001). Major complaints in the symptomatic PVD+ group included floaters (n = 2) and blurry vision (n = 5). The preoperative AULCSF (1.4 ± 0.1) was significantly lower in the symptomatic PVD+ group versus the PVD- group (p < 0.0001) and PVD+ group (p = 0.02). The preoperative AULCSF in the symptomatic PVD+ group was significantly improved after PPV (1.4 vs. 1.7, respectively, p = 0.002). CONCLUSIONS: PVD significantly decreased CSF in patients with MfIOL. Patients with symptomatic PVD exhibited the greatest decrease in CSF, which was significantly improved after PPV. Measurement of CSF and careful assessment of PVD may be useful in determining the appropriateness of surgical intervention for improving visual performance and satisfaction in MfIOL patients with symptomatic PVD.

Effect of posterior vitreous detachment on treat-and-extend versus monthly ranibizumab for neovascular age-related macular degeneration.

AIMS: To investigate the impact of posterior vitreous detachment (PVD) on the efficacy of treat-and-extend (T&E) ranibizumab in neovascular age-related macular degeneration. METHODS: In a post hoc analysis of a randomised controlled clinical trial, spectral-domain optical coherence tomography images of treatment-naïve patients randomised to receive T&E (n=265) or monthly (n=264) ranibizumab for 12 months were included. Certified, masked graders diagnosed the presence or the absence of complete PVD. The main outcome measures were the mean change in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) at month 12, the number of administered ranibizumab injections and the proportion of patients extended to more than 8 weeks. RESULTS: At baseline, complete PVD was present in 51% and 56% of patients in the monthly and T&E arms, respectively. Mean change in BCVA at month 12 was +9.0 (PVD) vs +9.5 letters (no PVD, p=0.78) in monthly treated eyes, and +6.0 (PVD) vs +7.5 letters (no PVD, p=0.42) in T&E treated eyes. Conversely, mean change in CRT at month 12 was -174 (PVD) vs -173 µm (no PVD, p=0.98) in the monthly arm, and -175 (PVD) vs -164 µm (no PVD, p=0.58) in the T&E arm. In T&E treated patients, the median number of injections was eight vs nine (p=0.035). 71% of PVD eyes were extended successfully, compared with 55% of eyes without PVD (p=0.005). CONCLUSION: PVD was not found to impact functional and anatomical outcomes of T&E ranibizumab therapy. However, patients without a complete PVD required more retreatments and were significantly less likely to be successfully extended. TRIAL REGISTRATION NUMBER: NCT01948830.

OUTCOME OF ACUTE NONTRAUMATIC VITREOUS HEMORRHAGE IN HEALTHY PATIENTS.

PURPOSE: To compare outcomes in dense vitreous hemorrhage versus mild vitreous hemorrhage due to nontraumatic posterior vitreous detachment. METHODS: We compared 315 eyes, divided into 2 patient groups, one with dense and the other with mild vitreous hemorrhage. The main outcome measures were final mean best-corrected visual acuity, number of retinal tears, number of retinal detachments, and the number of pars plana vitrectomy and/or scleral buckle surgeries. RESULTS: In 33.4% of the patients, posterior vitreous detachment without complications was found. Retinal breaks after posterior vitreous detachment were found in 59% of the eyes. Rhegmatogenous retinal detachment was principally treated with pars plana vitrectomy and scleral buckle. In nonvisible fundus hemorrhage group, 44.4% of the patients underwent vitrectomy. In visible fundus hemorrhage group, 9.52% of the patients underwent pars plana vitrectomy. The mean final visual acuity was 20/25, without significant difference between groups (P = 0.064). CONCLUSION: Acute, spontaneous, nontraumatic posterior vitreous separation with vitreous hemorrhage is associated with a high incidence of retinal complications. Close follow-up is necessary. We did not find significant differences in final visual acuity neither between the two groups nor among the treatments.

Reduced perfusion density of superficial retinal capillary plexus after intravitreal ocriplasmin injection for idiopathic vitreomacular traction.

BACKGROUND: To investigate, using optical coherence tomography angiography (OCT-A), changes in perfusion density and in the foveal avascular zone (FAZ) in eyes with idiopathic vitreomacular traction (VMT) after ocriplasmin injection. METHODS: In this pilot study, we enrolled sixteen VMT eyes treated with intravitreal ocriplasmin injection. Sixteen healthy eyes were considered as controls. Macular perfusion density in 3 plexuses [superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris (CC)] was calculated at baseline and at 1 month after injection. RESULTS: After injection, VMT anatomically resolved in 9 eyes (56.2%), whereas 7 eyes (43.8%) achieved an incomplete VMT separation. Superficial capillary plexus perfusion density was reduced significantly after injection (from 0.427 ± 0.027 to 0.413 ± 0.028; p = 0.0146), while no differences were noted in the DCP (p = 0.2717) nor in the CC (p = 0.6848). Study-eye perfusion density was statistically similar to control eyes in all three plexuses, both at baseline and at follow-up. The FAZ in the SCP area remained unchanged after injection (p = 0.168) but was significantly inferior to controls both at baseline and at 1 month (0.198 ± 0.074 vs. 0.196 ± 0.070; p = 0.007). CONCLUSIONS: Eyes with VMT have a perfusion density comparable to healthy controls, but a smaller FAZ. After ocriplasmin injection the perfusion density in the SCP is reduced, regardless the anatomical success. Limited by the small sample size and the pilot nature of the study, we found microvascular changes after ocriplasmin injection, which may be due to retinal traction release.

Cost-Effectiveness of Limited Vitrectomy for Vision-Degrading Myodesopsia.

PURPOSE: Patients afflicted with clinically significant vitreous floaters suffer from vision-degrading myodesopsia, characterized by impairment in contrast sensitivity function (CSF) and decreased quality of life. This study determined the cost-effectiveness of limited vitrectomy for this condition. DESIGN: Retrospective, interventional case series and third-party insurer cost-utility analysis. METHODS: Sixty-seven patients suffering from unilateral vitreous floaters (20 non-myopic patients with posterior vitreous detachment [PVD]; 17 myopic patients [>-2 diopters] without PVD; 30 myopic patients with PVD) completed the National Eye Institute Visual Function Questionnaire (VFQ-39) and were tested with best-corrected visual acuity (BCVA) and CSF measurements before and after limited vitrectomy. A reference case cost-utility analysis was performed. RESULTS: The mean VFQ-39 increased 19% (P < 0.00001) after surgery, with general vision improving 27% for the entire group and 37% for non-myopic PVD (P < 0.00001 for each). VFQ-39 correlations with time tradeoff utilities indicated a 14.4% improvement in quality of life. Mean BCVA improved 13.5% postoperatively (P < 0.00001) and CSF improved 53% (P < 0.00001). The incremental patient value gain conferred by limited vitrectomy was 2.38 quality-adjusted life-years (QALYs), and the average cost-utility ratio in 2018 U.S. real dollars was $1,574/QALY. CONCLUSIONS: Limited vitrectomy for vision-degrading myodesopsia is clinically effective, in that it improves BCVA, CSF, and patient well-being. It is also highly cost-effective ($1,574/QALY), with an average cost-utility ratio vs. no therapy that is superior to cataract surgery ($2,262/QALY), amblyopia therapy ($2,710/QALY), and retinal detachment repair ($45,304/QALY). Myopic patients without PVD had the lowest cost-utility ratio of all ($1,338/QALY).

Patient-reported prevalence of metamorphopsia and predictors of vision-related quality of life in vitreomacular traction: a prospective, multi-centre study.

OBJECTIVES: To report the prevalence and severity of metamorphopsia, estimate its impact on vision-related quality of life (VRQoL) and evaluate predictors of VRQoL in patients with vitreomacular traction (VMT). PATIENTS AND METHODS: A prospective, cross-sectional multi-centre study in the United Kingdom of 185 patients with VMT, with or without a full thickness macular hole (FTMH). Self-reported metamorphopsia was determined using the metamorphopsia questionnaire. VRQoL was assessed using the Visual Function Questionnaire (VFQ-25). Physicians recorded clinical and ocular characteristics in both eyes including a physician assessment of metamorphopsia. ANOVA and predicted least-squares means were used to estimate the impact of metamorphopsia on VRQoL. Predictors of VRQoL were assessed using ordinary-least-squares regression adjusting for clinically important variables. RESULTS: The prevalence of self-reported metamorphopsia was 69.7% (95% CI 62.6-76.3%) and was higher in eyes with a concomitant FTMH vs. without FTMH (85.4% vs. 64.2%). Physician assessment of metamorphopsia was 53.0% (95% CI: 45.5-60.3%). Comparing eyes with metamorphopsia vs. without metamorphopsia, the VFQ-25 composite score was lower (82.3 vs. 91.4), and mean VA (LogMAR) was worse (0.44 vs. 0.33). The largest difference in VFQ-25 scores was observed for near activities (metamorphopsia: 75.3, No metamorphopsia: 90.2). The adjusted model showed that metamorphopsia severity and age were significantly associated with lower VFQ-25 scores. CONCLUSION: Metamorphopsia was highly prevalent in patients with VMT and associated with significantly lower VRQoL. Physician assessment of symptoms underestimated the self-reported presence of metamorphopsia. Metamorphopsia severity acts as a predictor of impaired VRQoL, over and above decrements due to reduced vision.

The role of posterior vitreous detachment on the efficacy of anti-vascular endothelial growth factor intravitreal injection for treatment of neovascular age-related macular degeneration.

PURPOSE: A prospective cohort study investigating the effect of posterior vitreous detachment (PVD) on the efficacy of intravitreal bevacizumab for exudative age-related macular degeneration (AMD), in view of evidence that the vitreoretinal interface impacts the severity of the disease. METHODS: Treatment-naïve AMD eyes with (+) complete PVD and without (-) PVD on ultrasonography received three monthly and then pro re nata bevacizumab injections. Best-corrected visual acuity (BCVA) on Snellen charts and optical coherence tomography (OCT) findings were recorded for 12 months. Secondary analysis included PVD definition and group allocation according to OCT baseline scan. RESULTS: Forty-one eyes of 34 patients met the inclusion criteria. At 12 months, median BCVA improved by 0.12 logMAR in the PVD+ group [interquartile range (IQR) -0.52, 0.03, P = 0.140] and remained the same in the PVD- group (IQR -0.12, 0.15, P = 0.643). Median central retinal thickness improved by 43.5 µm and 43 µm in the PVD+ (IQR -143, 3, P = 0.016) and PVD- group (IQR -90, -14, P = 0.008), respectively. All parameters were similar in the two groups at final follow up (P > 0.05). The secondary analysis included 32 eyes of 26 patients and showed no significant differences between the groups at the 12 months endpoint (P > 0.05). CONCLUSION: Our findings show no significant impact of PVD as assessed by ultrasound or by OCT on visual and anatomical outcomes in exudative AMD treated with bevacizumab.

The vitreopapillary interface in healthy and glaucoma: posterior vitreous detachment in the vitreopapillary interface study.

PURPOSE: To investigate the vitreopapillary interface (VPI) in health and glaucoma according to the different stages of posterior vitreous detachment (PVD) formation. METHODS: Prospective single centre study including healthy subjects and glaucoma patients. PVD staging was performed with spectral domain optical coherence tomography. Gender, age, lens status and refractive error were assessed in both groups. Glaucoma patients additionally had a comprehensive ophthalmological investigation including intraocular pressure measurement, visual field testing and confocal imaging of the optic nerve head. RESULTS: Data on 523 subjects (993 eyes) were included from the VPI study (clinicaltrials.gov NCT02290795) database (493 eyes of 258 healthy subjects and 500 eyes of 265 glaucoma patients). Healthy subjects were significantly younger than primary open angle glaucoma patients (59.7 ± 14.81 versus 70.0 ± 10.78 years, p < 0.001), but were otherwise matched for refractive error and gender. Significantly more glaucomatous eyes were pseudophakic (26.6% versus 5.1%). Including only phakic nonoperated eyes from subjects between 50 and 80 years old decreased the age difference between healthy and open angle glaucoma (64.1 ± 8.0 versus 65.9 ± 6.7 years, p = 0.051). Comparing these subgroups rendered similar average ages for PVD stages 0 and 4, in contrast to the significant older age for the glaucoma subgroup in stage 1 (64.1 ± 6.01 versus 61.4 ± 8.38 years, p < 0.001) and a trend towards significance in stage 3 (70.8 ± 69.8 versus 67.5 ± 5.92 years, p = 0.051). CONCLUSION: The VPI study is a large clinical trial investigating the VPI in health and glaucoma. A subset of glaucoma patients seems to experience stages 1-3 of PVD formation at older age compared to healthy subjects.

Influence of the Vitreoretinal Interface on the Treatment with Anti-VEGF for Exudative Age-Related Macular Degeneration.

PURPOSE: To investigate the influence of the vitreoretinal interface on the outcomes of different ranibizumab regimens for exudative age-related macular degeneration. METHODS: We conducted a retrospective subanalysis of 2 prospective clinical trials. Patients were treated with ranibizumab for 12 months according to 3 different regimens: pro-re-nata (PRN), treat and extend (T&E), and monthly. Vitreoretinal interface was assessed for absence (group ON) or presence (group OFF) of posterior vitreous detachment (PVD). RESULTS: We included 64 eyes from 64 patients. Visual improvement was poorer for group ON (0.3 ± 10.7 letters) than for group OFF (9.2 ± 13.3; p = 0.007). A significant difference in letters of improvement between groups was observed in the PRN cohort (ON: -5.0 ± 12.9; OFF: 11.4 ± 11.9; p = 0.003), but not in the cohorts with monthly (ON: 5.7 ± 7.8; OFF: 7.9 ± 15.2; p = 0.735) or T&E (ON: 4.3 ± 4.3; OFF: 7.8 ± 11.1; p = 0.424) treatment. CONCLUSION: The negative impact of absence of PVD is regimen dependent, with monthly dosing providing similar outcomes to PVD patients. In the absence of PVD (group ON), PRN should be avoided, and T&E might be an alternative.

The effects of aging vitreous on contrast sensitivity function.

PURPOSE: Contrast sensitivity function (CSF) declines with age. When unassociated with cataracts, this is hypothesized to be due to macular ganglion cell complex (GCC) thinning. However, other studies found associations with increased vitreous echodensity and posterior vitreous detachment (PVD). We investigate the relationship between CSF, vitreous echodensity, PVD, and GCC thickness as related to age in the same subjects. METHODS: Age, CSF (Weber index: %W), vitreous echodensity (quantitative ultrasonography [QUS]), lens status (phakia or pseudophakia), best-corrected visual acuity (BCVA), and GCC thickness (SD-OCT) were evaluated in 57 eyes of 57 subjects with (n = 32, mean age = 62 years) and without (n = 25, mean age = 44 years) PVD (P < 0.001). A multivariate linear regression analysis was performed to assess the effects of independent variables on CSF. RESULTS: CSF was 51.2% worse in eyes with PVD (2.98 ± 0.31 %W) compared to no PVD (1.97 ± 0.24 %W; P < 0.001). QUS was 55.8% greater in eyes with PVD than those without (P < 0.001). Among all subjects, PVD status, vitreous echodensity, and age were the only independent variables demonstrating significant effects on CSF. Lens status, BCVA, and GCC thickness did not demonstrate association with CSF. CONCLUSIONS: PVD, vitreous echodensity, and age are determinants of CSF. PVD and increased vitreous echodensity are each associated with diminished CSF, independent of age. Thus, in the absence of GCC thinning and cataracts, vitreous changes may be a cause of decreased CSF with age.

PREDICTIVE FACTORS OF VISUAL OUTCOME FOR VITREOMACULAR TRACTION SYNDROME AFTER VITRECTOMY.

PURPOSE: To assess the long-term functional and anatomical outcomes for vitreomacular traction syndrome (VMT) after vitrectomy and to analyze the predictive factors regarding visual outcome. METHODS: A retrospective, consecutive case series of 22 eyes in 22 patients with VMT who underwent vitrectomy to relieve macular edema were studied. Eyes were classified into two groups according to the diameter of vitreomacular adhesion based on spectral domain optical coherence tomography: Group 1 (14 eyes) focal attachment ≤1,500 µm; and Group 2 (eight eyes) broad attachment >1,500 µm. RESULTS: Mean postoperative follow-up was 25.4 months (range, 6-68). The preoperative mean logarithm of the minimal angle of resolution visual acuity was 0.73 (20/107), which significantly improved to 0.49 (20/62) postoperatively (P < 0.01). Seventeen eyes (77%) had Snellen visual acuity improvement ≧ two lines, and nine eyes had improvement ≧ three lines. The improvement of visual acuity was significantly better in Group 1 than in Group 2 (2.7 lines vs. 0.8 lines) (P = 0.03). The preoperative mean central macular thickness was 563 µm ± 176 µm, which significantly improved to 298 µm ± 69 µm postoperatively (P < 0.01). In multivariate analysis, better final visual acuity was significantly associated with Group 1 VMT (P < 0.01) and with shorter symptom duration (P < 0.01). Greater improvement of visual acuity was also significantly associated with younger age of patients (P = 0.02) and with Group 1 VMT (P < 0.01). In linear regression analysis, patients with longer symptom duration had worse final visual acuity (ß = 0.02) and patients of younger age had greater visual acuity improvement (ß = 0.008). CONCLUSION: Most patients of VMT gained significant functional and anatomical improvements after vitrectomy. Group 1 optical coherence tomography pattern, shorter symptom duration, and younger age are significant predictive factors of better visual outcome.

PARS PLANA VITRECTOMY AND LENSECTOMY FOR ECTOPIA LENTIS WITH AND WITHOUT THE INDUCTION OF A POSTERIOR VITREOUS DETACHMENT.

PURPOSE: Posterior hyaloid removal during pars plana vitrectomy and lensectomy for ectopia lentis is commonly performed, but may increase the risk of intraoperative retinal breaks and postoperative retinal detachment. This study evaluated outcomes after pars plana vitrectomy and lensectomy with or without posterior hyaloid removal. METHODS: This retrospective observational cohort study included ectopia lentis cases that underwent pars plana vitrectomy and lensectomy (2005-2014), with or without intraoperative induction of a posterior vitreous detachment (PVD). The primary outcome was postoperative retinal detachment. The secondary outcomes were the incidence of iatrogenic retinal breaks, and change in visual acuity. RESULTS: Twenty-six cases were included. The posterior hyaloid was preserved intraoperatively in 11 cases (non-PVD group). In the remainder (15 cases), the vitreous was removed completely (PVD group). Postoperative retinal detachment occurred in 2 cases in each group (18.2% non-PVD vs.13.3% PVD, P = 0.7). Intraoperative breaks occurred more frequently in the PVD group (2 vs. 9 cases; P = 0.03). There was no difference in mean improvement in visual acuity (7 [PVD] vs. 3 [non-PVD] ETDRS lines; P = 0.2). CONCLUSION: The preservation of posterior hyaloid attachment during vitreolensectomy for ectopia lentis was associated with fewer iatrogenic retinal breaks. Postoperative retinal detachment did not seem to be influenced by the choice of surgical technique.

CORRELATION BETWEEN CENTRAL FOVEAL THICKNESS AND VISUAL ACUITY IN PATIENTS WITH IDIOPATHIC VITREOMACULAR TRACTION.

PURPOSE: To evaluate the impact of preoperative central foveal thickness (CFT) on visual acuity after surgery in patients with idiopathic vitreomacular traction and to calculate a cut-off value in preoperative CFT. METHODS: Thirty-five patients with idiopathic vitreomacular traction were evaluated retrospectively. A complete ophthalmological examination including spectral domain optical coherence tomography was performed preoperatively and at 12 months after the surgery. Receiver operating characteristic analysis was used to determine the critical point for the CFT associated with improvement of 10 or more letters in visual acuity on the Early Treatment Diabetic Retinopathy Study. RESULTS: Among 35 patients, the mean CFT at postoperative 12 months was significantly decreased from baseline (P = 0.001). Preoperative CFT and visual improvement were not significantly correlated (r = -0.090, P = 0.605), whereas preoperative CFT and preoperative visual acuity were significantly correlated (r = 0.757, P < 0.001). Improvement in CFT and visual improvement were also correlated significantly (r = 0.449, P = 0.007). According to the receiver operating characteristic analysis, the threshold CFT was 471 µm. When 15 patients with CFT thickness under 471 µm were evaluated, preoperative CFT was significantly correlated with improvement in visual acuity after the surgery (r = 0.561, P = 0.030). CONCLUSION: Preoperative CFT is important for the visual prognosis of patients with vitreomacular traction. Preoperative CFT of these patients should be considered in surgical decisions.

A Study of the Natural History of Vitreomacular Traction Syndrome by OCT.

PURPOSE: To examine the natural history of vitreomacular traction syndrome (VMTS) in the absence of other ocular comorbidities. DESIGN: Retrospective clinical case series. PARTICIPANTS: A total of 183 eyes of 159 patients diagnosed with VMTS with no other ocular comorbidity. METHODS: Patients with VMTS were identified from an OCT database at Moorfields Eye Hospital, London. Sequential OCT scans and patient notes were reviewed over a minimum period of 6 months. Data collected included patient demographics, best-corrected visual acuity, and OCT features of vitreomacular adhesion. Contingency tests and binary logistic modeling were used to identify baseline predictors of stability and progression. MAIN OUTCOME MEASURES: The rates of spontaneous resolution (defined by release of traction), progression to full-thickness macular hole, and surgical intervention were analyzed. RESULTS: Presenting visual acuity was 0.3±0.3 logMAR units. The mean length of follow-up was 17.4±12.1 months. During this period, VMTS persisted in 60% and resolved in 20% (occurring on average at 15 months). Of the remainder, 12% developed a macular hole and 8% elected to proceed with surgery for symptoms. Focal adhesion <1500 µm was present in 87%. A premacular membrane with macular pucker (PMM) was present in 20%. With persistent VMTS, vision and central foveal thickness remained unchanged. The relative risk of resolution increased in those cases with better presenting visual acuities, lesser foveal thicknesses, and no associated PMMs; vision significantly improved in those cases with resolution. CONCLUSIONS: VMTS persists in the majority of patients but despite this, visual acuities did not deteriorate significantly over the study period unless patients developed a full-thickness macular hole or required surgical intervention for symptoms. Resolution spontaneously occurred in 20%, with an improvement in vision.

Calculating the individual probability of successful ocriplasmin treatment in eyes with VMT syndrome: a multivariable prediction model from the EXPORT study.

BACKGROUND/AIMS: To evaluate predictive factors for the treatment success of ocriplasmin and to use these factors to generate a multivariate model to calculate the individual probability of successful treatment. METHODS: Data were collected in a retrospective, multicentre cohort study. Patients with vitreomacular traction (VMT) syndrome without a full-thickness macular hole were included if they received an intravitreal injection (IVI) of ocriplasmin. Five factors (age, gender, lens status, presence of epiretinal membrane (ERM) formation and horizontal diameter of VMT) were assessed on their association with VMT resolution. A multivariable logistic regression model was employed to further analyse these factors and calculate the individual probability of successful treatment. RESULTS: 167 eyes of 167 patients were included. Univariate analysis revealed a significant correlation to VMT resolution for all analysed factors: age (years) (OR 0.9208; 95% CI 0.8845 to 0.9586; p<0.0001), gender (male) (OR 0.480; 95% CI 0.241 to 0.957; p=0.0371), lens status (phakic) (OR 2.042; 95% CI 1.054 to 3.958; p=0.0344), ERM formation (present) (OR 0.384; 95% CI 0.179 to 0.821; p=0.0136) and horizontal VMT diameter (µm) (OR 0.99812; 95% CI 0.99684 to 0.99941, p=0.0042). A significant multivariable logistic regression model was established with age and VMT diameter. CONCLUSION: Known predictive factors for VMT resolution after ocriplasmin IVI were confirmed in our study. We were able to combine them into a formula, ultimately allowing the calculation of an individual probability of treatment success with ocriplasmin in patients with VMT syndrome without FTHM.