The natural history of tractional cystoid macular edema

To describe clinical outcomes in a series of patients with tractional cystoid macular edema, a variant of vitreomacular traction syndrome.

Twelve consecutive patients (15 eyes) with tractional cystoid macular edema of maximum diameter of ≤550 μm and presenting corrected-distance visual acuity of ≤0.3 (Snellen ≥20/40) were studied. Each patient underwent ophthalmic examination, including visual acuity testing in the logarithm of the minimal angle of resolution system, slit-lamp biomicroscopy, and optical coherence tomography. All patients were monitored at four-monthly intervals, unless a subjective change in symptoms prompted earlier follow-up.

The mean corrected-distance visual acuity (±standard deviation) at presentation was 0.17 (Snellen 20/30) (±0.17). The mean (±standard deviation) maximum diameter of vitreofoveolar adhesion was 267 (±139) μm. After a mean follow-up of 9.2 (±7.4) months, 8 eyes exhibited spontaneous and complete posterior vitreous detachment, with resolution of the tractional cystoid macular edema and restoration of normal foveal anatomy in 6 of these eyes and persistence of a single foveal cyst in 2 of these eyes. The final corrected-distance visual acuity (±standard deviation) in the 5 eyes that underwent spontaneous and complete posterior vitreous detachment improved from 0.20 (Snellen 20/32) (±0.13) to 0.16 (Snellen 6/8) (±0.12; P = 0.53).

Complete posterior vitreous detachment occurred spontaneously in 53% of eyes with tractional cystoid macular edema in this series.