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

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

doi: 10.1097/IAE.0000000000001015
Original Study

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 μm to 323 ± 121 μm.

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.

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 fullthickness macular hole.

*Macula, Vitreous and Retina Associates of Costa Rica, San José, Costa Rica;

University of Buenos Aires, Argentina;

University of Puerto Rico, San Juan, Puerto Rico;

§The King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia;

Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland;

**Retina Department, Ramón y Cajal University Hospital, Madrid, Spain;

††VISSUM Madrid, Madrid, Spain;

‡‡National Ophthalmological Foundation, Rosario University, Bogota, Colombia;

§§Centro Caracas Ophthalmologic Clinic, Caracas, Venezuela;

¶¶Conde Valenciana Foundation, Mexico City, Mexico;

***OFTALMOS University of Buenos Aires, Buenos Aires, Argentina;

†††La Fe Hospital, University of Valencia, Valencia, Spain;

‡‡‡Ricardo Palma Clinic, Lima, Peru;

§§§Association for Blindness Prevention in Mexico, Mexico City, Mexico;

¶¶¶Retina and Vitreous Unit, Department of Ophthalmology, Moises Broggi Hospital, Barcelona, Spain;

****Department of Ophthalmology, Vision Institute, Federal University of Sao Paulo, Sao Paulo, Brazil;

††††University of Colorado, School of Medicine, Denver, Colorado;

‡‡‡‡Department of Ophthalmology, Federal University of Goias, Goiânia, Brazil; and

§§§§LV Prasad Eye Institute, Hyderabad, India.

Reprint requests: Lihteh Wu, MD, Asociados de Macula, Vitreo y Retina de Costa Rica, Apdo 144-1225 Plaza Mayor, San José, Costa Rica; e-mail: LW65@cornell.edu

Presented in part at 47th Annual Meeting of the Retina Society, the Union League, Philadelphia, PA, and the 29th Meeting of the Club Jules Gonin, Zurich, Switzerland.

None of the authors have any financial/conflicting interests to disclose.

© 2016 by Ophthalmic Communications Society, Inc.