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Nathan Steinle, Dilsher Dhoot, Dante Joseph Pieramici, Robert F See, Alessandro Castellarin, Steven Couvillion, Maan Nasir, Robert L Avery; Comparison of Three Non-surgical Treatments for Vitreomacular Traction (VMT). Invest. Ophthalmol. Vis. Sci. 201657(12):.
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© ARVO (1962-2015); The Authors (2016-present)
Evaluate the efficacy and safety of C3F8 gas, SF6 gas, and intravireal ocriplasmin (IVO) for the treatment of symptomatic VMT. Furthermore, dynamic optical coherence tomography (OCT) microstructural changes were evaluated to better predict successful release of VMT with gas (pneumatic vitreolysis).
113 consecutive patients with VMT were treated with one of three interventions: 54 patients received IVO, 32 patients received C3F8 gas injection, and 27 patients received SF6 gas injection. Patients receiving gas were given 0.25 cc of 100% gas (for both C3F8 and SF6). All injections were performed using aseptic technique in a clinic setting. Mean follow up was greater than 6 months.VMT release rates, visual acuity (VA), tonometry, and outer retinal band (ORB) changes on OCT were retrospectively reviewed. For the two gas groups (C3F8 and SF6), dynamic OCT movements were carefully reviewed. Specifically, patients were evaluated with back and forth horizontal and vertical micro-movements (voluntary saccades) on live OCT imaging to characterize the VMT adhesion as either "taut" or "mobile". VMT release rates within the two gas groups were reviewed to determine if taut versus mobile VMT had a higher degree of successful release.
VMT release rate at final follow up was 84% (27/32) with C3F8 gas, 56% (15/27) with SF6 gas, and 48% (26/54) with ocriplasmin [SF6 versus ocriplasmin: p=0.53, C3F8 versus ocriplasmin: p<0.01, C3F8 versus SF6: p=0.01]. Thus, C3F8 was superior to both SF6 and IVO; while SF6 performed similarly to IVO.VA improved slightly in all groups, with no significant change in tonometry. ORB changes were noted more frequently in IVO versus either gas combined (p<0.05). No retinal breaks occurred in this series and no vitreous hemorrhages occurred."Mobile" VMT on dynamic (live) OCT released more frequently than "taut" VMT (p<0.05) with gas.
C3F8 gas injection showed superior VMT release rates to both IVO and SF6. Minimal ORB changes were noted with C3F8 and SF6 compared to IVO.To our knowledge, the 113 eyes included in this review represent by far the largest series to date regarding the comparison of two types of gases and ocriplasmin for VMT. This series shows highly positive results regarding the use of intravitreal gas for VMT, especially C3F8.Furthermore, by evaluating baseline dynamic (live) OCT characteristics of VMT, predictability of successful VMT release can be enhanced.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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