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Calvin E Mein, Clement K Chan; Pneumatic Vitreolysis (PVL) for the Treatment of Vitreomacular Traction Syndrome (VMT). Invest. Ophthalmol. Vis. Sci. 2017;58(8):3688.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the efficacy of Pneumatic Vitreolysis for the treatment of VMT with or without a Stage 2 macular hole (MH).
A retrospective review of eyes with VMT treated with PVL from 2010 to 2016 was performed. Eyes with VMT with our without small Stage 2 MH were treated with 0.3cc of C3F8 gas injection. Patients with MH were instructed to position face down for 3 days.
55 consecutive eyes (53 patients) with VMT treated with PVL were analyzed. Mean age was 69.7 years. There were 14 males and 39 females. Successful VMT release was achieved in 47 eyes ( 85%). Forty seven eyes developed complete PVD (85.4 %) with average of 3.4 weeks. Of 37 eyes with VMT only, 30 had release of VMT. Of the eighteen eyes with stage 2 MH, 10 had complete closure (55%). Of the 8 eyes with MH not closed by PVL, all were successfully treated with vitrectomy. For the entire group, baseline BSCVA and final BSCVA was 20/50 and 20/38 respectively (p-value 0.001). Mean baseline and final BSCVA for eyes with Stage 2 MH was 20/64 and 20/33 resepectively(p-value 0.001). For those eyes with VMT only, baseline and final BSCVA was 20/49 and 20/41 respectively (p value .015).Results of univariate analysis showed a significant relationship between success rate and VMT size within 1 DA (c2 = 12.70, p = .002), success rate and lack of diabetes mellitus (c2 = 8.41, p =.008), and a trend between success and lack of cellophane membrane (c2 = 3.13, p = .077).A stepwise logistic regression showed that younger age was the strongest predictor (Odds Ratio (OR)=0.83, 95%CI (0.71,0.98) followed by lack of diabetes mellitus (OR=19.91, 95% CI (1.59,249.61)).Complications: one eye with VMT successfully treated with PVL developed Stage 3 MH after 5 months.One eye with VMT that failed orcriplasmin treatment and was later treated with PVL developed a retinal detachment. One eye developed a retinal tear 1 week after PVL.
PVL with C3F8 gas injection done in the office setting with limited face down positioning appears to be highly effective for treatment of VMT with 85% of eyes achieving VMT release. PVL was capable of closing small Stage 2 macular holes with a success rate of 55%. All stage 2 MHs that failed to close with PVL were successfully closed with vitrectomy, ILM peeling and gas fluid exchange.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Case #18: 74 y/o female with VMT at baseline BSCVA 20/80
Case 18: OCT at final visit 8 months s/p PVL. BSCVA is 20/30
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