Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India.
Retina. 2022 Jul 1;42(7):1277-1283. doi: 10.1097/IAE.0000000000003456.
To compare pneumatic vitreolysis and pars plana vitrectomy in the management of focal symptomatic vitreomacular traction (VMT).
Patients aged 18 years or older, with idiopathic focal symptomatic VMT and best-corrected visual acuity <20/40, without any other retinal pathology were randomized to undergo pneumatic vitreolysis (Group 1) or pars plana vitrectomy (Group 2). The primary outcome measure was resolution of traction confirmed with optical coherence tomography at 3 months. Secondary outcome measures were to compare changes in best-corrected visual acuity, central foveal thickness, and complications if any.
A total of 30 eyes of 30 patients were included with 15 eyes in each group. Vitreomacular traction resolved successfully in 12 of 15 (80%) eyes in Group 1 and in all (100%) eyes in Group 2 (P = 0.224). The mean visual acuity improved from 0.80 ± 0.26 (20/126 Snellen's equivalent) to 0.70 ± 0.46 logMAR (20/100 Snellen's equivalent) in Group 1 (P = 0.71) and from 0.904 ± 0.44 (20/160 Snellen's equivalent) to 0.47 ± 0.26 logMAR (20/59 Snellen's equivalent) in Group 2 (P = 0.0016). Although 4 of 15 (26.66%) eyes in Group 1 had formation of full-thickness macular hole and 7 eyes required resurgery (4 for full-thickness macular hole and 3 for unresolved VMT), none in the pars plana vitrectomy group had any complications requiring resurgery (P = 0.0063). Two eyes in the pars plana vitrectomy group had intraoperative deroofing of the fovea leading to full-thickness macular hole.
Pars plana vitrectomy is better than pneumatic vitreolysis as a single intervention in the management of focal symptomatic VMT.
比较气动玻璃体切割术与经平坦部玻璃体切除术治疗局灶性症状性玻璃体黄斑牵引（VMT）。
年龄在 18 岁或以上、患有特发性局灶性症状性 VMT 且最佳矫正视力<20/40、无其他视网膜病变的患者被随机分为接受气动玻璃体切割术（第 1 组）或经平坦部玻璃体切除术（第 2 组）。主要结局测量指标是 3 个月时光学相干断层扫描（OCT）确认的牵引缓解情况。次要结局测量指标是比较最佳矫正视力、中心凹视网膜厚度和任何并发症的变化。
共纳入 30 例 30 眼，每组 15 眼。第 1 组 15 眼中 12 眼（80%）成功缓解玻璃体黄斑牵引，第 2 组 15 眼中全部（100%）成功缓解（P=0.224）。第 1 组平均视力从 0.80±0.26（20/126 视力表等效）提高至 0.70±0.46 logMAR（20/100 视力表等效）（P=0.71），第 2 组从 0.904±0.44（20/160 视力表等效）提高至 0.47±0.26 logMAR（20/59 视力表等效）（P=0.0016）。第 1 组 15 眼中有 4 眼（26.66%）形成全层黄斑裂孔，7 眼需要再次手术（4 例全层黄斑裂孔，3 例未解决的 VMT），而平坦部玻璃体切除组无一例需要再次手术（P=0.0063）。第 2 组中有 2 眼在平坦部玻璃体切除术中发生黄斑区去顶，导致全层黄斑裂孔。
与气动玻璃体切割术相比，经平坦部玻璃体切除术作为局灶性症状性 VMT 的单一干预措施效果更好。
