PNEUMATIC VITREOLYSIS FOR RELIEF OF VITREOMACULAR TRACTION
Clement K Chan, Jason N Crosson, Calvin E Mein, Noha Daher, Clement K Chan, Jason N Crosson, Calvin E Mein, Noha Daher
Abstract
Purpose: To evaluate the outcome of perfluoropropane (C3F8) gas injection for symptomatic vitreomacular traction (VMT) with or without Stage 2 macular hole (MH).
Methods: A retrospective review of eyes with VMT treated with 0.3 mL of C3F8 gas was performed. Patients avoided the supine position until gas resolution. Patients with small MH maintained partial face-down positioning.
Results: Forty-nine consecutive patients (50 eyes) with symptomatic VMT underwent pneumatic vitreolysis between 2010 and 2016. A posterior vitreous detachment developed in 43 eyes (86.0%) after a single gas injection, at a median of 3.0 weeks. Twenty-eight of 35 eyes (80.0%) with VMT only and all 15 eyes (100%) with a small Stage 2 MH developed a posterior vitreous detachment, with MH closure in 10 of 15 eyes (66.7%). Median baseline and last best spectacle-corrected visual acuities were 20/50 and 20/40, respectively (P < 0.001). Mean follow-up time was 11.1 ± 9.9 months. Rate of posterior vitreous detachment was reduced with presence of diabetes mellitus (25%) and with thick cellophane membrane (50%). Univariate analysis showed increased VMT release for eyes with VMT extent within 1 disk area (χ = 13.1, P = 0.002), eyes with absence of diabetes mellitus (χ = 8.8, P = 0.007), and eyes with Stage 2 MH (χ = 5.47, P = 0.019); there was a trend between success and lack of thick cellophane membrane (χ = 3.32, P = 0.068). Results using logistic regression also showed younger age (P = 0.012), followed by better baseline best spectacle-corrected visual acuity (P = 0.044), lack of diabetes mellitus (P = 0.077), and female gender (P = 0.045) to be predictors of increased VMT release. One VMT-only eye formed a MH and another VMT-only eye developed a retinal detachment. Both eyes responded to vitrectomy.
Conclusion: Pneumatic vitreolysis with limited face-down position is a viable option for treating VMT with few adverse events. More studies are needed to elucidate its indications, benefits, and risks.
Conflict of interest statement
None of the authors have any financial/conflicting interests to disclose.
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References
- Sebag J. Is pharmacologic vitreolysis brewing? Retina 2002;22:1–3.
- Sebag J. Pharmacologic vitreolysis, premise and promise of the first decade. Retina 2009;29:871–874.
- Duker JS, Kaiser PK, Binder S, et al. The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole. Ophthalmology 2013;120:2611–2619.
- Hikichi T, Yoshida A, Trempe CL. Course of vitreomacular traction syndrome. Am J Ophthalmol 1995;119:55–61.
- Sulkes DJ, Ip MS, Baumal CR, et al. Spontaneous resolution of vitreomacular traction documented by optical coherence tomography. Arch Ophthalmol 2000;118:286–287.
- Lecleire-Collet A, Muraine M, Siahmed K, Brasseur G. Spontaneous resolution of vitreomacular traction associated with diabetic macular edema. Eur J Ophthalmol 2004;14:430–433.
- Odrobina D, Michalewska Z, Michalewski J, et al. Long-term evaluation of vitreomacular traction disorder in spectral-domain optical coherence tomography. Retina 2011;31:324–331.
- Hwang DJ, Park KH, Woo SJ. Spontaneous resolution of vitreomacular traction syndrome with persistent vitreofoveal adhesion observed on spectral-domain optical coherence tomography. Can J Ophthalmol 2012;47:e17–e19.
- Almeida DRP, Chin EK. Spontaneous resolution of vitreomacular traction in two patients with diabetic macular edema. Case Rep Ophthalmol 2014;5:66–71.
- Theodossiadis GP, Grigoropoulos VG, Theodoropoulou S, et al. Spontaneous resolution of vitreomacular traction demonstrated by spectral-domain optical coherence tomography. Am J Ophthalmol 2014;157:842–851.
- Dimopoulos S, Bartz-Schmidt KU, Gelisken F, et al. Rate and timing of spontaneous resolution in a vitreomacular traction group: should the role of watchful waiting be re-evaluated as an alternative to Ocriplasmin therapy. Br J Ophthalmol 2015;99:350–353.
- John VJ, Flynn HW, Smiddy WE, et al. Clinical course of vitreomacular adhesion managed by initial observation. Retina 2014;34:442–446.
- Tzu JH, John VH, Flynn HW, et al. Clinical course of vitreomacular traction managed initially by observation. Ophthalmic Surg Lasers Imaging Retina 2015;46:571–576.
- Stefanini FR, Mauricio M, Falabella P, et al. Profile of ocriplasmin and its potential in the treatment of vitreomacular adhesion. Clin Ophthalmol 2014;8:847–856.
- Stalmans P, Benz MS, Gandorfer A, et al. Enzymatic vitreolysis with ocriplasmin for vitreomacular traction and macular holes. N Engl J Med 2012;367:606–615.
- Freund KB, Shah SA, Shah VP. Correlation of transient vision loss with outer retinal disruption following intravitreal ocriplasmin. Eye (Lond) 2013;27:773–774.
- Fahim AT, Khan NW, Johnson MW. Acute panretinal structure and functional abnormalities after intravitreous ocriplasmin injection. JAMA Ophthalmol 2014;132:484–486.
- Tibbetts MD, Reichel E, Witkin AJ. Vision loss after intravitreal ocriplasmin: correlation of spectral-domain optical coherence tomography and electroretinography. JAMA Ophthalmol 2014;132:487–490.
- Kim JE. Safety and complications of ocriplasmin. Ocriplasmin, ocriplasmin, oh, how safe art thou? JAMA Ophthalmol 2014;132:379–380.
- Hager A, Seibel I, Riechardt A, et al. Does ocriplasmin affect the RPE-photoreceptor adhesion in macular holes? Br J Ophthalmol 2015;99:635–638.
- Chan CK, Wessels IF, Friedrichsen EJ. Treatment of idiopathic macular holes by induced posterior vitreous detachment. Ophthalmology 1995;102:757–767.
- Costa RA, Cardillo JA, Morales PH, et al. Optical coherence tomography evaluation of idiopathic macula hole treatment by gas-assisted posterior vitreous detachment. Am J Ophthalmol 2001;132:264–266.
- Jorge R, Costa RA, Cardillo JA, et al. Optical coherence tomography evaluation of idiopathic macula hole treatment by gas-assisted posterior vitreous detachment. Am J Ophthalmol 2006;142:869–871.
- Mori K, Saito S, Gehlbach PL, Yoneya S. Treatment of stage 2 macula hole by intravitreal injection of expansile gas and induction of posterior vitreous detachment. Ophthalmology 2007;114:127–133.
- Rodrigues IA, Stangos AN, McHugh DA, Jackson TL. Intravitreal injection of expansile perfluoropropane (C3F8) for the treatment of vitreomacular traction. Am J Ophthalmol 2013;155:270–276.
- Johnson MW. How should we release vitreomacular traction: surgically, pharmacologically, or pneumatically? Am J Ophthalmol 2013;155:203–205.
- Steinle NC, Dhoot DS, Quezada RC, et al. Treatment of vitreomacular traction with intravitreal perfluoropropane (C3F8) injection. Retina 2016. Sep 27. [Epub ahead of print].
- Day S, Martinez JA, Nixon PA, et al. Intravitreal sulfur hexafluoride injection for the treatment of vitreomacular traction syndrome. Retina 2016;36:733–737.
- Dugel PU, Tolentino M, Feiner L, et al. Results of the 2-year Ocriplasmin for Treatment for Symptomatic Vitreomacular Adhesion Including Macular Hole (OASIS) randomized trial. Ophthalmology 2015;123:2232–2247.
- Sebag J. Pharmacologic vitreolysis (Guest Editorial). Retina 1998;18:1–3.
- Sebag J. Molecular biology of pharmacologic vitreolysis. Trans Am Ophthalmol Soc 2005;103:473–494.
- Foos RY, Wheeler NC. Vitreoretinal juncture. Synchysis senilis and posterior vitreous detachment. Ophthalmology 1982;89:1502–1512.
- Thresher RJ, Ehrenberg M, Machemer R. Gas-mediated vitreous compression: an experimental alternative to mechanized vitrectomy. Graefes Arch Clin Exp Ophthalmol 1984;221:192–198.
- Miller J, Lean JS, Miller H, Ryan SJ. Intravitreal expanding gas bubble. A morphologic study in the rabbit eye. Arch Ophthalmol 1984;102:1708–1711.
- Eisner G. Biomicroscopy of the Peripheral Fundus; An Atlas and Textbook. Berlin, Germany: Springer-Verlag; 1973:106–107.
- Haller JA, Stalmans P, Benz MS, et al. Efficacy of intravitreal ocriplasmin for treatment of vitreomacular adhesion: subgroup analyses from two randomized trials. Ophthalmology 2015;122:117–122.
- Palacio AC, Gupta A, Nesmith BL, et al. Vitreomacular adhesion evolution with age in healthy human eyes. Retina 2016. Jun 15. [Epub ahead of print].
- Chatziralli I, Theodossiadis G, Parikakis E, et al. Real-life experience after intravitreal ocriplasmin for vitreomacular traction and macular hole: a spectral-domain optical coherence tomography prospective study. Graefes Arch Clin Exp Ophthalmol 2016;254:223–233.
- Prospero Ponce CM, Stevenson W, Gelman R, et al. Ocriplasmin: Who is the best candidate? Clin Ophthalmol 2016;10:485–495.
Source: PubMed