ANATOMICAL AND FUNCTIONAL OUTCOMES OF SYMPTOMATIC IDIOPATHIC VITREOMACULAR TRACTION: A Natural History Study From the Pan American Collaborative Retina Study Group

作者：Wu Lihteh^*; Zas Marcelo; Berrocal Maria H; Arevalo J Fernando; Figueroa Marta; Rodriguez Francisco; Serrano Martin; Graue Federico; Alezzandrini Arturo; Gallego Pinazo Roberto; Roca Jose A; Iglicki Matias; Dalma Weishauz Jose; Kozak Igor; Collado Alberto; Badal Josep; Maia Mauricio; Salcedo Villanueva Guillermo; Quiroz Mercado Hugo; Fromow Guerra Jans; Lozano Rechy David; Avila Marcos; Chhablani Jay

来源：Retina-The Journal of Retinal and Vitreous Diseases, 2016, 36(10): 1913-1918.

DOI：10.1097/IAE.0000000000001015

• vitreomacular traction
• macular hole
• vitrectomy
• ocriplasmin

Purpose:To describe the natural history of eyes with symptomatic idiopathic vitreomacular traction (VMT).Methods:Retrospective multicenter study of 168 eyes with spectral-domain optical coherence tomography (SD-OCT) findings consistent with idiopathic VMT. All eyes were graded according to SD-OCT findings. Grade 1 was defined as incomplete cortical vitreous separation with foveal attachment. Grade 2 was defined as Grade 1 plus intraretinal cysts or clefts. Grade 3 was defined as Grade 2 plus a foveal detachment. All patients were followed for at least 6 months.Results:There were 168 patients (51 men) with a mean age of 68.8 10.7 years. Patients were followed for a mean of 22.7 +/- 20.1 months. The mean duration of symptoms before the initial presentation was 3.65 +/- 5.42 months. At baseline, 72 eyes had Grade 1, 74 eyes had Grade 2, and 22 eyes had Grade 3 SD-OCT findings. Over the follow-up period, 36 eyes (21.4%) had spontaneous resolution of the VMT with normalization of the foveal anatomy. The mean time to resolution was 12.3 +/- 12.6 months. An unfavorable anatomical outcome occurred in 7.7% (13 of 168) of the eyes, with 6 eyes developing a lamellar macular hole and 7 eyes developing a full-thickness macular hole. This occurred at a mean of 10.3 +/- 10.7 months after the presentation. Subgroup analysis based on baseline SD-OCT grade showed that 4.1% (3 of 73) of Grade 1 eyes compared with 6.8% (5 of 74) of Grade 2 eyes, and 23.8% (5 of 21) of Grade 3 eyes developed a full-thickness macular hole or lamellar macular hole (P = 0.0109, chi-square test). In the remaining 119 eyes, at the last follow-up, 65 eyes had Grade 1, 42 eyes had Grade 2, and 12 eyes had Grade 3 VMT. On average, the best-corrected visual acuity improved from 0.40 +/- 0.35 logarithm of the minimum angle of resolution (Snellen, 20/50) at baseline to 0.35 +/- 0.36 logarithm of the minimum angle of resolution (Snellen, 20/45; P = 0.0372), and the mean central macular thickness improved from 350 +/- 132 m to 323 +/- 121 m.Conclusion:Spontaneous resolution of VMT occurred in 21.4% (36 of 168) of eyes after a mean follow-up of 11.4 +/- 12.6 months. An unfavorable anatomical outcome occurred in 7.7% (13 of 168) of eyes. The baseline SD-OCT grade may predict the progression to full-thickness macular hole.

• 出版日期2016-10