Faculty of Medicine, University of Toronto, Toronto, Canada.
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada ; and.
Retina. 2022 Jul 1;42(7):1219-1230. doi: 10.1097/IAE.0000000000003513.
To review predictive factors of spontaneous vitreomacular traction (VMT) release.
A systematic literature search was performed on Ovid MEDLINE, Embase, and Cochrane Library. Studies comparing spontaneously released VMT to persistent VMT were included. A meta-analysis was performed using a random effects model, and weighted mean difference, risk ratio (RR), and 95% confidence intervals (95% CI) were reported as appropriate.
Of a search of 258 studies, 12 studies were included, from which 272 of 934 eyes (29%) underwent spontaneous release. Mean age was 70.0 years, 37.2% of patients were men, and mean follow-up was 22.0 months. Significant predictive factors for spontaneous release were smaller VMT diameter (n = 177; weighted mean difference = -212.48 µm, 95% CI = [-417.36, -7.60], P = 0.04), epiretinal membrane absence (n = 162; RR = 2.17, 95% CI = [1.18, 3.97], P = 0.01), and right eye involvement (n = 76; RR = 2.10, 95% CI = [1.14, 3.88], P = 0.02). Nonsignificant factors were age, initial best-corrected visual acuity, sex, ocular comorbidity, fellow-eye posterior vitreous detachment, previous intravitreal injection, and VMT classification with focal defined as ≤400 µm. Mean release time was 15.3 months (n = 212). Mean best-corrected visual acuity improved from 0.34 ± 0.21 (Snellen 20/44) to 0.20 ± 0.58 logMAR (Snellen 20/32) postrelease (n = 121).
Smaller VMT diameter, epiretinal membrane absence, and right eye involvement may support spontaneous VMT release. If patients have tolerable symptoms, clinicians may consider observation in patients with these predictive factors.
回顾自发性玻璃体黄斑牵引（VMT）松解的预测因素。
在 Ovid MEDLINE、Embase 和 Cochrane 图书馆进行系统文献检索。纳入比较自发性 VMT 松解与持续性 VMT 的研究。使用随机效应模型进行荟萃分析，并报告适当的加权均数差、风险比（RR）和 95%置信区间（95%CI）。
在对 258 项研究进行检索后，纳入 12 项研究，其中 934 只眼中有 272 只（29%）发生自发性松解。平均年龄为 70.0 岁，37.2%的患者为男性，平均随访时间为 22.0 个月。自发性松解的显著预测因素为较小的 VMT 直径（n=177；加权均数差=-212.48 µm，95%CI=[-417.36，-7.60]，P=0.04）、无视网膜内膜（n=162；RR=2.17，95%CI=[1.18，3.97]，P=0.01）和右眼受累（n=76；RR=2.10，95%CI=[1.14，3.88]，P=0.02）。无统计学意义的因素为年龄、初始最佳矫正视力、性别、眼部合并症、对侧眼后玻璃体脱离、既往玻璃体腔内注射和 VMT 分类，其中以局灶性定义为≤400 µm。平均松解时间为 15.3 个月（n=212）。121 例患者的最佳矫正视力从 0.34±0.21（Snellen 20/44）改善至 0.20±0.58 logMAR（Snellen 20/32）（n=121）。
较小的 VMT 直径、无视网膜内膜和右眼受累可能支持自发性 VMT 松解。如果患者有可耐受的症状，临床医生可能会考虑在有这些预测因素的患者中进行观察。
