Abstract
Purpose:
To evaluate the prevalence of different stages of vitreomacular interface (VMI) diseases including vitreomacular adhesion, vitreomacular traction (VMT) and full thickness macular holes using a novel OCT staging system. In addition, to evaluate the prevalence of patients who may qualify for treatment with ocriplasmin.
Methods:
Retrospective, IRB-approved, consecutive case series of all patients with ICD-9 code of 362.54 (macular cyst, hole or pseudohole) and in whom spectral domain OCT was obtained. Patients were excluded if they had poor OCT image quality or localization. Patients were classified into the following categories: macular cyst without hole, pseudohole (partial thickness hole within an epiretinal membrane with clinical appearance of macular hole), lamellar hole (inner retinal defect without full thickness defect), vitreomacular traction without hole and full-thickness macular hole (FTMH). FTMHs were further sub-classified based on size as: minimum diameter (MD) < 250µm, 250-400µm or > 400µm. Presence of vitreous traction, epiretinal membrane, and/or cystic spaces was also quantified. The fellow eyes of patients with FTMH were studied to determine the presence of vitreomacular adhesion (stage 0 macular hole).
Results:
437 eyes of 375 patients were included in the study. 39 eyes (8.9%) had macular cyst without a hole. A lamellar hole was present in 53 eyes (12.1%) and a pseudohole in 66 eyes (15.1%). 40 eyes (9%) had VMT without a FTMH. 217 eyes (49.7%) had a FTMH. 72 eyes (16.5%) had a FTMH <250µm MD, 47 eyes (10.7%) had FTMH between 250-400µm MD and 98 eyes (22.4%) had FTMH >400µm MD. In patients with FTHM, 22 (10.1%) had a fellow eye with VMA (Stage 0 MH). In total, 84 eyes (19.2%) had traction, 166 eyes (37.9%) had ERM, and 254 eyes (58.1%) had cystic changes adjacent to the hole. 75 eyes (17.1%) with VMT, excluding FTMH >400µm, qualified for ocriplasmin therapy based on clinical studies, of which 56/75 eyes (74.7%) had no ERM and were good candidates for ocriplasmin therapy.
Conclusions:
We present the prevalence of VMI disease using a novel OCT based staging system. 17.1% of all eyes with a diagnosis code 362.54 had symptomatic vitreomacular traction that qualified for ocriplasmin therapy. 74.7% of these eyes were considered good candidates for ocriplasmin therapy. 10.1% of fellow eyes with FTMH had stage 0 macular hole, indicating a need to continue screening the fellow eye.
Keywords: 586 macular holes •
550 imaging/image analysis: clinical