Dimopoulos Spyridon, Bartz-Schmidt Karl-Ulrich, Gelisken Faik, Januschowski Kai, Ziemssen Focke
Centre for Ophthalmology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany.
Br J Ophthalmol. 2015 Mar;99(3):350-3. doi: 10.1136/bjophthalmol-2014-304961. Epub 2014 Oct 23.
The incidence of spontaneous resolution of vitreomacular traction (VMT) is low in studies of Ocriplasmin that have had a limited follow-up. Previous studies did not look for morphological parameters in the natural history using spectral-domain ocular coherence tomography (SD-OCT) imaging. The purpose of this study was to investigate how often and when spontaneous VMT resolution occurs in candidates for Ocriplasmin therapy.
The study is a retrospective chart review of patients who would have high chances of a benefit by an Ocriplasmin injection, without epiretinal membrane or vitreomacular adhesion of 1500 µm or more on SD-OCT. Main outcome measures were the frequency of complete VMT resolution and the best corrected visual acuity seen in the natural history.
Out of the 46 patients that were included after screening 889 SD-OCT images, 20 were found to exhibit spontaneous resolution during the follow-up period (median: 594 days, 95% CI 567 to 719 days), the majority after 6-12 months of observation (95% CI 266 to 617 days). The group with spontaneous VMT resolution and a mean improvement of one line in best corrected visual acuity included a few patients losing vision by macular hole formation. In the absence of resolution, patients lost on average one early treatment diabetic retinopathy study letter per year. Younger age was found to increase the chance of spontaneous resolution.
A shorter follow-up might underestimate the incidence of spontaneous VMT resolution as the functional outcome of watchful waiting. The likelihood of resolution does not seem to decrease after 12 months.
在玻璃体内注射ocriplasmin且随访有限的研究中，玻璃体黄斑牵引（VMT）自然消退的发生率较低。既往研究未使用频域光学相干断层扫描（SD - OCT）成像来探寻自然病程中的形态学参数。本研究的目的是调查在ocriplasmin治疗候选者中VMT自然消退的频率及发生时间。
本研究是一项回顾性病历审查，针对那些接受ocriplasmin注射可能获益且SD - OCT显示无视网膜前膜或玻璃体黄斑粘连达1500 µm或以上的患者。主要观察指标为VMT完全消退的频率以及自然病程中最佳矫正视力情况。
在筛查889张SD - OCT图像后纳入的46例患者中，20例在随访期间出现自然消退（中位数：594天，95%可信区间567至719天），大多数在观察6 - 12个月后出现（95%可信区间266至617天）。VMT自然消退且最佳矫正视力平均提高一行的组中，有少数患者因黄斑裂孔形成而视力下降。在未出现消退的患者中，每年平均丧失1个早期糖尿病视网膜病变研究视力表字母。发现年龄较小会增加自然消退的几率。
作为密切观察等待的功能结果，较短的随访可能会低估VMT自然消退的发生率。12个月后消退的可能性似乎并未降低。
