Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida.
Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida.
Ophthalmol Retina. 2022 Oct;6(10):893-898. doi: 10.1016/j.oret.2022.04.021. Epub 2022 May 5.
To review the clinical course and outcomes of patients with idiopathic vitreomacular traction (VMT) managed initially by observation.
Retrospective chart review including patients with idiopathic VMT based on clinical symptoms and findings on OCT between January 1, 2015, and February 15, 2021.
The study included 436 eyes of 317 patients with a mean age of 72.2 years ± 8.9 at initial visit and mean follow-up time of 34 months ± 19.2.
Vitreomacular traction severity grade was ascribed to each patient using previously published grading criteria. Grade 1 denoted incomplete cortical vitreous separation with attachment at the fovea and visible distortion of the foveal surface. Grade 2 included intraretinal cysts or clefts along with grade 1 findings. Grade 3 included subfoveal fluid along with grade 2 traits.
The rate of spontaneous release, grade at baseline compared with grade at final follow-up, and outcomes of interventions, if performed.
At baseline, mean best corrected visual acuity (BCVA) was 20/40. Baseline OCT demonstrated grade 1 VMT in 212 eyes (48.6%), grade 2 VMT in 172 eyes (39.4%), and grade 3 VMT in 52 eyes (11.9%). Among eyes that were initially grade 1, 25.0% had spontaneous release of VMT (median, 290.0 days; mean, 404.5 days ± 323.9), 50.9% remained stable, and 10.4% worsened. Among eyes that were initially grade 2, 14.5% had spontaneous release of VMT (median, 570.0 days; mean, 692.9 days ± 477.5), 55.2% remained stable, 4.7% improved, and 2.3% worsened. Among eyes that were initially grade 3, 5.8% had spontaneous release of VMT (median, 790.0 days; mean, 839.3 days ± 246.7), 28.8% remained stable, and 5.8% improved. Of the 436 eyes, macular hole development occurred in 42 eyes (9.6%). Pars plana vitrectomy was performed in 94 of 436 eyes (21.6%) with mean BCVA before pars plana vitrectomy of 20/78 and final follow-up BCVA of 20/55.
This study demonstrates the generally stable clinical course of VMT when managed initially by observation. Stable VMT grade was the most frequent outcome, and eyes with grade 1 VMT were more likely to undergo spontaneous release than eyes with grade 2 or 3.
回顾特发性玻璃体黄斑牵引（VMT）患者经观察初始治疗的临床病程和结局。
回顾性图表审查，纳入 2015 年 1 月 1 日至 2021 年 2 月 15 日期间基于临床症状和 OCT 发现的特发性 VMT 患者。
该研究包括 317 名患者的 436 只眼，平均年龄为 72.2 岁±8.9 岁，平均随访时间为 34 个月±19.2 个月。
使用先前发表的分级标准为每位患者分配玻璃体黄斑牵引严重程度等级。1 级表示不完全性皮质玻璃体分离，伴黄斑区附着和可见的黄斑表面扭曲。2 级包括视网膜内囊肿或裂孔，同时伴有 1 级表现。3 级表示伴有 2 级特征的黄斑下积液。
自发松解率、基线时的分级与最终随访时的分级比较，以及如果进行干预的结果。
基线时，最佳矫正视力（BCVA）平均为 20/40。基线 OCT 显示 212 只眼（48.6%）为 1 级 VMT，172 只眼（39.4%）为 2 级 VMT，52 只眼（11.9%）为 3 级 VMT。在最初为 1 级的眼中，25.0%发生 VMT 自发松解（中位数为 290.0 天；平均为 404.5 天±323.9），50.9%保持稳定，10.4%恶化。在最初为 2 级的眼中，14.5%发生 VMT 自发松解（中位数为 570.0 天；平均为 692.9 天±477.5），55.2%保持稳定，4.7%改善，2.3%恶化。在最初为 3 级的眼中，5.8%发生 VMT 自发松解（中位数为 790.0 天；平均为 839.3 天±246.7），28.8%保持稳定，5.8%改善。在 436 只眼中，42 只眼（9.6%）发生黄斑裂孔。436 只眼中的 94 只眼（21.6%）接受了玻璃体切除术，玻璃体切除术前行最佳矫正视力为 20/78，最终随访时的最佳矫正视力为 20/55。
本研究表明，特发性玻璃体黄斑牵引经观察初始治疗时通常具有稳定的临床病程。稳定的 VMT 分级是最常见的结果，而 1 级 VMT 眼比 2 级或 3 级 VMT 眼更有可能发生自发松解。
