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Vishak John, Harry Flynn, William Smiddy, Adam Carver, Robert Leonard, Homayoun Tabandeh, David Boyer; Clinical Course of Unoperated Eyes with Vitreofoveal Traction. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2786. doi: https://doi.org/.
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The purpose of the study was to investigate the unoperated clinical course of patients with vitreofoveal traction [VFT] in terms of visual acuity and anatomy using spectral domain optical coherence tomography [SD-OCT].
A multi-center, non-comparative chart review was performed of VFT patients examined between 2004 and 2012 who had SD-OCT findings consistent with vitreofoveal traction but for whom the attending physician elected observational management. VFT was graded based on OCT findings at initial and follow-up examinations. Fellow eyes of macular hold patients and patients with advanced macular disease affecting vision were excluded. Stage 1 was incomplete cortical vitreous separation with attachment at the fovea; Stage 2 was Stage 1 findings along with any intraretinal cysts or clefts; and Stage 3 was the same as Stage 2, but also included the presence of subretinal fluid. Best-corrected visual acuity (BCVA) was recorded at each examination.
In the current study, 107 eyes of 86 patients were identified as having VFT by SD-OCT at three retina clinics. The mean age was 72.7 years. The mean time of follow-up was 708 days or 23 months [range 1 to 91 months]. At their initial visit, patients had a mean BCVA of log 0.268 [20/37 with a range 20/20 to 20/200] , and 44 eyes [41%] had Stage 1 VFT, 55 eyes [51%] with Stage 2, and 8 eyes [7%] with Stage 3 VFT. Spontaneous vitreous separation from the foveal attachment occurred in 31% of patients. During the study follow-up, four eyes underwent vitrectomy and membrane peel due to progression to a macular hole, and another eye for progressive visual loss. At the last examination, the mean BCVA remained stable from baseline.
The unoperated clinical course of idiopathic VFT is generally favorable when the presenting visual acuity is relatively good and symptoms are mild. Approximately one-fourth of patients resolved spontaneously at a mean follow-up of 15 months. Thus, non-interventional therapy should be considered in patients with idiopathic VFT.
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