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Peter Stalmans, Benedicte Lescrauwaet, Koenraad Blot; A RETROSPECTIVE COHORT STUDY IN PATIENTS WITH DISEASES OF THE VITREOMACULAR INTERFACE (ReCoViT). Invest. Ophthalmol. Vis. Sci. 2014;55(13):309.
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© ARVO (1962-2015); The Authors (2016-present)
Data on vitreomacular (VM) pathology are scarce. The purpose of this study was to characterize OCT-based ocular features present in patients diagnosed with diseases of the VM interface: vitreomacular adhesion (VMA), vitreomacular traction (VMT) and macular hole (MH), associated symptomatology, and rates over time of interventions and of spontaneous resolution.
Retrospective, single-center, observational study. The cohort included patients from a large tertiary care ophthalmology center in Flanders, who had at least 1 outpatient visit between July 2009 and August 2013, when only watchful waiting and vitrectomy were available as treatment options, before the era of pharmacological vitreolysis. Patients were enrolled with OCT findings related to disorders of the VM interface, with or without visual symptoms. Patients diagnosed with concurrent retinal disorders influencing visual acuity and patients with isolated epiretinal membrane were excluded. Survival curves were performed for time-to-event analysis. Results focus on eyes with baseline VM interface pathology and with at least one follow-up visit.
The total cohort included 687 eyes from 500 patients, of which 557 eyes from 401 patients had at least one follow-up visit (analysis population). The majority of eyes presented with MH without VMT (236/557, 42.4%), or VMT alone (223/557, 40.0%). Of the patients with at least one follow-up, 23.9% of VMT eyes had a vitrectomy performed within 1 year of diagnosis, and the chances of spontaneous resolution within 1 year were 21.5%. In eyes followed for MH with VMT at baseline, progression to MH without VMT occurred in 17.4% within 1 year. Metamorphopsia was the reason for referral in 22.3% of patients with VMT, and in 60.9% of patients with MH with VMT. A high proportion of the 401 patients (38.9%) also had VM pathology in the fellow eye.
Metamorphopsia was a hallmark symptom of vitreomacular pathology, and the prevalence of metamorphopsia in eyes with diseases of the VM interface may be highly underestimated. Frequently disease of the VM interface is found bilaterally. In eyes with VMT and VMT+MH, rates of spontaneous resolution within 1 year were small, and a significant number required vitrectomy. A watchful waiting approach in these eyes may delay treatment intervention and increase the risk of disease progression.
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