Qi Biying, Yang Xiaohan, Yu Yanping, Zhang Ke, Wu Xijin, Wang Xinbo, Jia Qinlang, Feng Xiao, Liu Wu
Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; and.
Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China.
Retina. 2024 Mar 1;44(3):429-437. doi: 10.1097/IAE.0000000000003972.
To investigate the predictive factors for postsurgical visual prognosis in patients with vitreomacular traction (VMT).
This retrospective study enrolled 31 eyes from 29 patients who underwent vitrectomy for idiopathic VMT with a follow-up period of ≥3 months. The VMT was divided into three grades based on optical coherence tomography images: Grade 1 denoted partial vitreomacular separation with foveal attachment; Grade 2 exhibited intraretinal cysts or cleft with grade 1 findings; and Grade 3 was Grade 2 plus the subretinal fluid.
Three eyes developed a full-thickness macular hole after surgery, all of which were Grade 3 patients. In the rest 28 eyes, the mean postoperative follow-up period was 23.3 ± 25.8 months. The postoperative central foveal thickness ( P = 0.001) and final best-corrected visual acuity (BCVA; P < 0.001) were both significantly improved from baseline. Fifteen eyes (53.8%) gained ≥ two Snellen lines. Multilinear regression analysis showed that the worse the baseline BCVA ( P = 0.004), or the more advanced the VMT grade ( P = 0.049), the worse the final BCVA. Baseline BCVA was negatively associated with the postoperative visual improvement ( P < 0.001). Those Grade 3 patients with baseline Snellen BCVA of ≥20/40 were more likely to achieve a final Snellen BCVA of ≥20/25 ( P = 0.035).
The VMT grade is an important predictive factor for the postsurgical visual prognosis. Surgical intervention should be performed as early as possible for Grade 3 patients to prevent further disease progression and maximize the postsurgical visual benefit.
探讨玻璃体黄斑牵引（VMT）患者术后视力预后的预测因素。
本回顾性研究纳入了29例因特发性VMT接受玻璃体切除术且随访时间≥3个月的患者的31只眼。根据光学相干断层扫描图像将VMT分为三个等级：1级表示部分玻璃体黄斑分离伴黄斑中心凹附着；2级表现为视网膜内囊肿或裂隙并伴有1级表现；3级为2级加上视网膜下液。
3只眼术后出现全层黄斑裂孔，均为3级患者。其余28只眼中，术后平均随访时间为23.3±25.8个月。术后中心凹厚度（P = 0.001）和最终最佳矫正视力（BCVA；P < 0.001）均较基线有显著改善。15只眼（53.8%）视力提高≥两行。多线性回归分析显示，基线BCVA越差（P = 0.004），或VMT等级越高（P = 0.049），最终BCVA越差。基线BCVA与术后视力改善呈负相关（P < 0.001）。那些基线Snellen BCVA≥20/40的3级患者更有可能获得最终Snellen BCVA≥20/25（P = 0.035）。
VMT等级是术后视力预后的重要预测因素。对于3级患者应尽早进行手术干预，以防止疾病进一步进展并使术后视力获益最大化。
