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W. Lee, J.T. Thompson, R.N. Sjaarda; Visual Outcomes of Vitrectomy in Vitreomacular Traction Syndrome in Phakic and Pseudophakic Eyes . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3051.
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Purpose: To evaluate and compare the results of vitrectomy in the treatment of vitreomacular traction syndrome in phakic and pseudophakic eyes. Methods: Retrospective review of 50 consecutive eyes which had vitrectomy for vitreomacular traction syndrome. The procedure included removal of an attached posterior hyaloid in the macula often associated with an epiretinal membrane. The mean followup was 2.2 years (range = 0.45 to 10 years). Eighteen eyes were pseudophakic preoperatively. Thirteen eyes remained phakic, and 19 eyes had cataract extraction by the final exam. Results: For all eyes, the mean visual acuities were 20/125+2 preoperatively, 20/100+2 at 3 months, and 20/70+1 at a mean followup of 2.2 years. In phakic eyes that never had cataract extraction (N=13), the mean visual acuities were 20/160-2 preop, 20/100+2 at 3 months, and 20/100-1 at a mean followup of 2.2 years. Progression of nuclear sclerotic cataract developed in 92.3% of these phakic eyes. In phakic eyes which had subsequent cataract extraction (N=19), the mean visual acuities were 20/100 preop, 20/100 at 3 months and 20/80 +2 at a mean followup of 3.3 years. In eyes which were pseudophakic preoperatively (N=18), the mean visual acuities were 20/100 preop, 20/80 at 3 months, and 20/40-2 at a mean followup of 1.1 years. The improvement in visual acuity between the preop and final exam was not significant for the two phakic groups but was significant for eyes which were pseudophakic preop and postop (P<0.0001). The visual acuity improved by at least 2 lines in 53.9% of phakic eyes that remained phakic, in 68.4% of phakic eyes with subsequent cataract extraction, and in 83% of preoperatively pseudophakic eyes. The visual acuity decreased by 2 or more lines in 15.4% of phakic eyes that remained phakic, in 21.0% of phakic eyes with subsequent cataract extraction, and in none of the eyes which were pseudophakic preoperatively. Mean visual acuity improved by 2.1 lines in phakic eyes which remained phakic and by 3.6 lines in pseudophakic eyes which remained pseudophakic. Mean visual acuity improved only 1.3 lines in phakic eyes with subsequent cataract extraction because 36.8% of these eyes developed cystoid macular edema or recurrent epiretinal membranes. Conclusions: Vitrectomy for vitreomacular traction syndrome improved visual acuity in most eyes. Visual results were excellent in pseudophakic eyes but were less favorable in phakic eyes due to nuclear sclerotic cataracts and in eyes which became pseudophakic postoperatively due to cystoid macular edema or recurrent epiretinal membranes.
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