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David Almeida, Eric K Chin, James C Folk, Karim Rahim, Stephen R Russell; Predictive factors for the spontaneous resolution of vitreomacular traction. Invest. Ophthalmol. Vis. Sci. 2014;55(13):327.
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© ARVO (1962-2015); The Authors (2016-present)
To examine variables that are predictive for the spontaneous resolution of vitreomacular traction syndromes (VMT). It is currently unknown what factors, if any, are predictive for the spontaneous release of VMT.
Retrospective case-control study of 61 patients with VMT and a minimum of three months of follow-up time. Optical coherence tomography (OCT) anatomic variables were characterized according to broad (>400 microns) versus focal (<400 microns) adhesions and by degree of inner versus outer retinal involvement. Treatment variables were investigated according to previous intravitreal injections of vascular endothelial growth factor (VEGF) inhibitors. Spontaneous release of VMT (VMT-SR) was defined as patients that experienced resolution of VMT with observation alone or following injection with anti-VEGF agents but without surgical intervention or ocriplasmin. A binary logistic regression model was created to ascertain significant prognostic variables predictive for the spontaneous release of VMT. Main outcome measures were defined as anatomic (OCT) and treatment (intravitreal injections) variables prognostic for the spontaneous release of VMT.
Of the 61 patients identified, 21 (35%) experienced spontaneous resolution of their VMT and 40 (65%) did not. Patients in the VMT-SR group were significantly associated with having only inner retinal distortion, but not outer retinal involvement, on OCT imaging (p=0.0129) and previous treatment with intravitreal injections of anti-VEGF (p=0.0181). Binary logistic regression modeling revealed anatomic (OCT inner retinal anatomy involvement, p=0.001597) and treatment (previous intravitreal injections, p=0.01127) factors as prognostic variables predictive of spontaneous release of VMT. Odds ratio (OR) for the anti-VEGF injections was 7.39 (sensitivity 0.52, specificity 0.88) and for the OCT anatomic variable was 10.45 (sensitivity 0.95, specificity 0.35). The combination of the injection and OCT variables resulted in an OR of 16.28 (p=0.0001662).
Eyes with VMT causing only inner retinal distortion on OCT and or having previous or ongoing intravitreal injections of anti-VEGF are more likely to develop spontaneous VMT release without the need for surgical intervention or ocriplasmin. These are novel findings that may help clinicians with management decisions when seeing patients with VTM.
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