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Gina Yu, Jorge G Arroyo, Kyle V Marra; Ocular Coherence Tomographic Findings in Patients with Vitreomacular Traction Treated with Pneumatic Vitreolysis, Intravitreal Ocriplasmin, or Vitrectomy with Membrane Peeling. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1223.
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To evaluate the resolution rate of vitreomacular traction (VMT) after receiving one of the following treatments, as compared to intravitreal placebo (control): (1) in-office intraocular C3F8 gas injection (pneumatic vitreolysis (PV)), (2) intravitreal ocriplasmin (IVO), or (3) pars plana vitrectomy with membrane peeling (PPV)
This review retrospectively analyzed 33 medical records (n=35 eyes) from VMT patients who underwent PV, IVO, PPV, or a control injection. All treatments were administered by a single surgeon at Beth Israel Deaconess Medical Center (BIDMC). PV patients received an injection of 0.3 mL of C3F8 gas and instructed to face down 15 minutes per hour while awake for 48 hours. IVO patients had an injection of Jetrea 125 ug per the package insert guidelines. PPV patients had vitrectomy with epiretinal and internal limiting membrane (ERM & ILM) peeling. Control patients received injections of anti-VEGF for age-related macular degeneration. The primary outcome measure was VMT resolution as established by optical coherence tomography (OCT) at day 28. The visual acuity (VA) at month 6, the OCT-measured central foveal thickness (CFT: distance between ILM and retinal pigment epithelium at fovea) at days 0 and 28, and resulting complications were recorded.
Zero out of 10 control (0%), 3 out of 7 IVO (42.9%; p=0.10), 7 out of 8 PV (87.5%; p<0.01) and 10 out of 10 PPV patients (100%; p<0.01) experienced VMT resolution at day 28. A third of IVO (33.3%) and PPV (33.3%) patients and a majority of PV patients (80%) had VA improvement. Difference in CFT before and after treatment was not significant in any treatment group (PV: p=0.10, IVO: p=0.07, and PPV p=0.50). No PV, 1 IVO (33.3%), and 3 PPV (33.3%) patients developed worse VA. No patients developed retinal tears or detachment. One PV (12.5%) and no IVO and PPV patients developed a macular hole.
PV effectively provided VMT release compared to control and had a higher rate of release compared to IVO. PV also had the highest rate of VA improvement. Both PV and PPV had statistically significantly higher rates of VMT resolution than control but IVO did not. This study suggests PV could provide a readily accessible and minimally invasive alternative to PPV and IVO, but future randomized, controlled studies to compare efficacies is necessary.
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