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Bartlett H. Hayes, H M. Lambert, Arthur W. Willis, Joseph A. Khawly, Eric R. Holz; Surgery For Vitreomacular Traction. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4486.
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To review the visual and anatomic results and complications of surgery for vitreomacular traction.
Medical records of 168 patients who underwent pars plana vitrectomy for epiretinal membrane removal between January 1, 2006 and April 1, 2010 were reviewed for evidence of preoperative vitreomacular traction. Cases were included if there was evidence of vitreomacular traction on the preoperative Ocular Coherence Tomography (OCT) and in the operative report. One hundred forty-six cases were excluded from the study because the patient had diabetes mellitus, active uveitis, exudative macular degeneration, retinal detachment, vascular occlusion, or the posterior vitreous was detached preoperatively. Twenty-two cases met the above criteria, with all cases having at least 6 months follow-up.
All 22 patients underwent pars plana vitrectomy with 20-, 23-, or 25-gauge instruments. Surgery included creation of a posterior vitreous detachment, removal of the posterior cortical vitreous, and removal of epiretinal membranes, with peeling of the internal limiting membrane if indicated. Median preoperative visual acuity was 20/50, with a range from 20/25 to 20/400. Median postoperative visual acuity was 20/40, with a range from 20/20 to 20/400. Seventeen patients (77%) had improvement of at least one line of Snellen acuity. Four patients (18%) had unchanged acuity, and one patient (5%) had loss of one line of Snellen acuity. Five patients (23%) had a final acuity of 20/25 or better. The average preoperative central macular thickness was 467, with a range from 251 to 814. The average postoperative central macular thickness was 313, with a range from 222 to 831. The average time to obtain best postoperative acuity was 9 months, with a range from 2 weeks to 23 months. The average time to best visual acuity was 9.25 months for the 12 patients who had 20-gauge instrumentation, 5.5 months for the 7 patients who had 23-gauge instrumentation, and 3.67 months for the 3 patients who had 25-gauge instrumentation. Final acuity was comparable in all 3 groups. One patient developed a rhegmatogenous retinal detachment 5 months after surgery, one patient developed peripheral retinal tears 9 months after surgery, one patient developed exudative ARMD, and 4 patients developed recurrent epiretinal membranes
Surgery for vitreomacular traction in this series was associated with both improved visual acuity and a reduced central macular thickness in a high percentage of cases. There was a trend to faster recovery of best visual acuity in the patients with 25-gauge instrumentation. We plan to enroll additional patients in order to further evaluate this trend
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