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CLINICAL COURSE OF VITREOMACULAR ADHESION MANAGED BY INITIAL OBSERVATION

John, Vishak J. MD*; Flynn, Harry W. Jr MD*; Smiddy, William E. MD*; Carver, Adam MD; Leonard, Robert MD; Tabandeh, Homayoun MD; Boyer, David S. MD

doi: 10.1097/IAE.0b013e3182a15f8b
Original Study

Purpose: The purpose of the study was to investigate the clinical course of patients with idiopathic vitreomacular adhesion (VMA).

Methods: A noncomparative case series of patients who had clinical symptoms and spectral-domain optical coherence tomography findings consistent with VMA. The VMA was graded based on the optical coherence tomography findings at initial and follow-up examinations. Grade 1 was incomplete cortical vitreous separation with attachment at the fovea, Grade 2 was the Grade 1 findings and any intraretinal cysts or clefts, and Grade 3 was the Grade 2 findings and the presence of subretinal fluid.

Results: One hundred and six eyes of 81 patients were identified as having VMA by spectral-domain optical coherence tomography at 3 retina clinics. The mean age was 73 years and the mean time of follow-up was 23 months. Forty-three eyes (41%) had Grade 1 VMA, 56 eyes (52%) had Grade 2 VMA, and 7 eyes (7%) had Grade 3 VMA. By the last follow-up, spontaneous release of VMA occurred in 34 eyes (32%), and pars plana vitrectomy was performed in 5 eyes (4.7%). Mean best-corrected visual acuity was 0.269 logarithm of the minimum angle of resolution or 20/37 at baseline (range, 20/20–20/200) and logarithm of the minimum angle of resolution 0.251 or 20/35 at the last examination (range, 20/20–20/400).

Conclusion: In this selected patient cohort with mild symptoms, the clinical course of patients with VMA managed by initial observation was generally favorable.

In this selected patient cohort with mild symptoms, the clinical course of patients with vitreomacular adhesion managed by initial observation was generally favorable.

*Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida;

Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma School of Medicine, Oklahoma City, Oklahoma; and

Retina-Vitreous Associates Medical Group, Los Angeles, California.

Reprint requests: Harry W. Flynn, Jr., MD, 900 NW 17 Street, Miami, FL 33136; e-mail: hflynn@med.miami.edu

Supported in part by the National Institutes of Health (NIH), Bethesda, MD, Grant NIH P30-EY014801 and an unrestricted grant to the University of Miami from Research to Prevent Blindness, New York, NY.

V. J. John and A. Carver have no financial/conflicting interests to disclose. H. W. Flynn: Santen, Vindico; W. E. Smiddy: Alimera Scientific; R. Leonard: Regeneron; H. Tabandeh: Alcon, Allergan, Bausch & Lomb; D. S. Boyer: Aeripo, Alcon, Allegro, Allergan, Bausch & Lomb, Bayer, Genentech, GSK, Merck, Neurotech, Novartis, OphthalmicsORA, Pfizer, Inc., QLT, Inc., Regeneron Pharmaceuticals.

© 2014 by Ophthalmic Communications Society, Inc.