Abstract
Purpose :
The optimal treatment strategies for sVMT or small full-thickness macular holes (FTMHs) with VMT remains to be established. We compared the outcomes of treatment using either minimally-invasive EVL or the novel technique of PVL.
Methods :
A single centre retrospective review of consecutive patients with sVMT(with or without FTMH) treated with EVL or PVL. All patients fulfilled the British National Institute for Clinical Excellence(NICE) guidelines for treatment with ocriplasmin. EVL consisted of ocriplasmin injection 0.125mg(0.1 mL) without posturing. PVL involved intravitreal 100%C3F8(0.3c.c) gas injection and prone posturing for 3 days. Data obtained included demographics, year of treatment, visual acuity(VA) pre-and 4 weeks post-procedure, Optical coherence tomography(OCT) findings of area of VMT, intraretinal and subretinal changes secondary to focal VMT and presence of lamellar hole(LH) or FTMH. Primary outcome was defined as release of VMT. Secondary outcomes included restoration of normal macular contour, closure of FTMH, improvements in VA and the need for subsequent vitrectomy. Unpaired and paired t-tests were used for statistical analysis.
Results :
17 patients underwent EVL and 8 patients underwent PVL. Both groups were comparable in age. 50% in PVL and 41.18% in EVL groups had FTMH. VMT release was achieved in a significantly greater proportion of eyes in the PVL than EVL groups (87.5% vs17.6%, respectively; p=0.0003), and normal macular contour restored in 75% and 5.8% of eyes respectively. FTMH closure where present was not seen in any of the patients (n=7) in the EVL group while 50% in PVL group (n=4) had FTMH closure (p=0.03). 52.9% of patients in the EVL group required subsequent vitrectomy compared with 12.5% in the PVL group. There was no significant difference in VA pre- and post-treatment in either group. One eye which failed treatment with EVL was successfully treated with PVL developed an inferior retinal detachment, which was successfully reattached.
Conclusions :
Anatomical success was greater and the need for subsequent vitrectomy lower in the PVL group. Novel PVL treatment appears to be a more effective and cheaper option than EVL in this cohort of patients, with fewer patients requiring subsequent vitrectomy. Further prospective studies with larger groups of patients over a longer period will help to fully evaluate above observations.
This is a 2020 ARVO Annual Meeting abstract.