Abstract
Purpose :
Uncertainty exists regarding the natural history of vitreomacular adhesion (VMA) and vitreomacular traction (VMT) and patient or ocular characteristics that predispose toward release versus complications. We aim to evaluate the characteristics and outcomes of VMA and VMT at a tertiary care center.
Methods :
This retrospective longitudinal cohort study includes eyes from 2008 to 2020 with VMA or VMT with ≥6 months of follow-up. Eyes with ocular comorbidities were excluded. The visual acuity (VA), optical coherence tomography characteristics, outcomes and interventions were recorded.
Results :
One hundred ten eyes of 93 patients were identified. Of 58 eyes with VMA, 22 were focal (≤1500 μm in length) and 36 were broad (>1500 μm). The average age was 63.0±8.6 years. Eighteen (31.0%) spontaneously released, 9 focal and 9 broad. Average time to release was 31.4±27.8 months. A smaller proportion of patients ≥65 years old had spontaneous release (4/25) compared to patients <65 years old (11/25, p=0.03). Average VA was 20/23 at presentation, 20/24 at 12 months and 20/24 at release. Six eyes progressed to VMT.
Of 52 eyes with VMT, 45 were focal and 7 were broad. A higher proportion of VMT were focal compared to VMA (p<0.00001). The average age was 67.3±10.9 years. Seventeen (32.7%) spontaneously released, similar to proportions of spontaneously released VMA (p=0.85). Fifteen were focal and 2 were broad (p=0.80). Average time to release was 20.1±19.3 months. The proportion of patients with spontaneous VMT release ≥65 years old (5/15) versus <65 years old (8/28) were similar (p=0.75). Average VA was 20/35 at presentation, 20/34 at 12 months and 20/34 at release. Complications include lamellar holes (n=2) and full thickness macular hole (n=1). Seven eyes were treated. Three eyes received intravitreal ocriplasmin; 2 successfully released and the remaining patient opted for observation thereafter. Four eyes received pars plana vitrectomy. Proportions of patients who were male, pseudophakic or had epiretinal membranes (ERM) were not different between those who had spontaneous release of VMA or VMT versus those who did not.
Conclusions :
VMA may spontaneously release after years of observation, particularly in patients <65 years old. Rates of spontaneous VMA and VMT release are comparable. Sex, lens status, focal versus broad attachment, and presence of ERM do not affect spontaneous release of VMA or VMT.
This is a 2021 ARVO Annual Meeting abstract.