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Julian Elias Klaas, Nikolaus Feucht, Chris Lohmann, Mathias Maier; Vitreopapillary adhesion in eyes treated with pneumatic vitreolysis - a morphology-based study of the vitreoretinal interface. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5020.
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The presence of vitreopapillary adhesion (VPA) in the context of anomalous posterior vitreous detachment (PVD) has been frequently described in association with the formation and possible progression of vitreomacular traction syndrome (VMTS). The purpose of this SD-OCT-based morphological study was to evaluate the vitreoretinal interface (VRI) in patients with vitreomacular traction (VMT) for the existence of VPA before and after treatment with pneumatic vitreolysis.
In this retrospective, observational case study we examined the morphology of the VRI in 10 eyes of 10 consecutive patients (5 male, 5 female) with focal VMT (≤1500 µm) who were treated with pneumatic vitreolysis (perfluoropropane C3F8, 0,3 ml). Patients underwent complete ophthalmic evaluation, including SD-OCT examination immediately before and at recommended follow-up visits after the procedure. We carefully reviewed the morphology of the VRI for the presence of VPA in SD-OCT-scans (30°-longitudinal, radial and volume scans) at all visits during the first 8 weeks after pneumatic vitreolysis. We further evaluated SD-OCT data for significant classification parameters, including size of VMT as well as structural changes of retinal layers.
All eyes showed VMT with concomitant persisting VPA immediately before the procedure. With regards to post-surgical morphology of the VRI, 9 of 10 eyes (95%) showed VMT release in between the studied post-procedural interval of 8 weeks. Mean-time for VMT release was 18.57 days (SD=17,19). 3 of these eyes (33,33 %) revealed persistent VPA in the presence of VMT release (incomplete PVD). One eye showed persistent VMT with concomitant VPA in all follow-up-exams (5%). 6 of 10 patients (60%) showed both release of VMT as well as VPA release, morphologically correlating with a complete PVD in SD-OCT. In one patient a full thickness macular hole developed with consequential necessity of pars-plana-vitreoretinal surgery. We found no VPA release in presence of persisting VMT.
Pneumatic vitreolysis is considered to be a highly promising treatment option for VMTS by effectively inducing PVD in eligible cases. Our SD-OCT-based review showed comparable results of VMT release to previous studies. We found that VPA release as a result of pneumatic vitreolysis was in all cases preceded by release of VMT.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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