Long-term evaluation of vitreomacular traction disorder in spectral-domain optical coherence tomography

The aim of this article was to estimate the natural course of vitreomacular traction (VMT) disorder using high-resolution spectral-domain optical coherence tomography.

Nineteen eyes of 19 patients with idiopathic symptomatic VMT and who underwent spectral-domain optical coherence tomographic follow-up examinations were included in the retrospective observational study. The average observation period of all patients who underwent the examination was 8 months (±4.4 months). We observed microstructural changes in the macula and the position, length, and vector forces of the attached vitreous in the macular surface.

Mean best-corrected visual acuity in the first examination was logarithm of the minimum angle of resolution 0.40 ± 0.37, and the final best-corrected visual acuity was logarithm of the minimum angle of resolution 0.30 ± 0.32 (P > 0.05, t-test). The vitreous was totally detached in the macular region (posterior vitreous detachment) in 9 of 19 eyes in the last examination. Complete disappearance of intraretinal cystoid spaces occurred in 6 of 19 eyes, and in all these eyes, posterior vitreous detachment was present. In two eyes with outer lamellar macular hole, posterior vitreous detachment occurred and the outer lamellar macular hole closed. In one eye, a full-thickness macular hole developed, and in one eye, lamellar macular hole developed. In one eye with lamellar macular hole in the first examination, this spontaneously closed. In three eyes, macular morphology and vitreous adhesion did not change. Epiretinal membranes (ERMs) were recorded in six eyes, and in one of these eyes, ERMs developed during the follow-up. In eyes in which totally detached vitreous in the macular region (posterior vitreous detachment) was noted in the follow-up(9 eyes), mean maximal horizontal vitreous surface adhesion was 180 ± 84 μm. These eyes were without ERM. In eyes with persistent VMT in the follow-up (10 eyes), mean maximal horizontal vitreous surface adhesion was 600 ± 385 μm. In 6 of these 10 eyes, we recorded ERM in the last examination (P < 0.05).

Vitreous surface adhesion and persistence of ERM may be the prognostic factors for the natural course of the VMT. We observed spontaneous resolution of VMT in eyes with less vitreous surface adhesion and without ERMs. In eyes with higher vitreous surface adhesion or coexisting ERM, pars plana vitrectomy with internal limiting membrane peeling should perhaps be performed.