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K. Klein, V. Sarup, K. J. Wald; Comparative Study of Diabetic and Nondiabetic Patients With Vitreomacular Traction. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4697.
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To study the natural and post-surgical course of vitreomacular traction (VMT) among diabetics and non-diabetics.
Retrospective case series of 18 eyes diagnosed with VMT by Optical Coherence Tomography (OCT). VMT was defined as focal fractional elevation of the fovea by a solitary adhesion of the posterior hyaloid interface. Detailed Chart review and serial scans analyzed.
18 eyes (17 patients); 8 men and 9 women; age range 55-85 years (average 70 years) were studied. 56% (10/18) were found to be diabetics. The average age at presentation was similar in diabetics and non-diabetics. 70% of the diabetics had VMT in association with proliferative retinopathy. Laser therapy kept the retinopathy in check. Surgery group: 50% (9/18 eyes) needed surgery; 5/9 eyes were from diabetics. The average age at surgery for diabetics was 65.8 years, while non-diabetics had surgery at an average age of 71.5 years. Average visual acuity prior to surgery was 20/100 and all eyes improved at least 2 Snellen lines. Average final visual acuity was 20/50 with an average follow up of 8 months after surgery. Observation group: 50% (9/18 eyes) were observed for an average of 15 months. 5/9 eyes were from diabetics. The average age at the beginning of observation was 72 years. The average age was 75 years for diabetics while the average age was 67.5 years for non-diabetics. Average visual acuity at the initiation of the observation period was 20/60. 67% (6/9) maintained same visual acuity, 22% (2/9) improved at least 2 Snellen lines (2/9), and 11% (1/9) had worsening of visual acuity. OCT demonstrated VMT in all eyes. 17% (3/18) had sub-retinal fluid; all three of these eyes subsequently required surgery.
VMT is generally a stable condition, and good surgical results can be expected in both diabetics and non-diabetics. Diabetic patients seemed to need surgery at an earlier age. Presence of sub-retinal fluid seems to be a prognostic factor indicating the need for subsequent surgery. OCT continues to be an indispensable tool in diagnosis and repeated evaluation of VMT patients. Management of VMT is similar to other cases of epiretinal membrane disorders.
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