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OCT imaging enhances observation as initial management strategy for VMT
Study examines clinical course and natural history of vitreomacular traction to determine ideal management options.
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Managing vitreomacular traction through initial observation and OCT imaging may be a favorable clinical course of action, according to a study.
Vitreomacular traction (VMT) can present with decreased vision, metamorphopsia and photopsia, but can also be relatively asymptomatic. Therefore, the clinical course and natural history of VMT leave practitioners with varied management options.
“I don’t think there’s really any one ideal classification system [to evaluate VMT],” lead investigator Jonathan H. Tzu, MD, told Ocular Surgery News. “There’s the international classification study, published previously, but our classification is slightly different and looks at the degree of distortion at the foveal area.”
The noncomparative case series, published in Ophthalmic Surgery, Lasers and Imaging Retina, evaluated 230 eyes of 185 patients with VMT, with a diagnosis made from clinical symptoms and spectral-domain OCT findings.
“It’s important to evaluate patients other than with just the OCT,” Tzu said. “[However], having OCT allows us to follow [patients] fairly closely to really know the changes at a close level. Until they develop a more serious problem, they can just be watched and usually their visual acuity is still good. It depends on how symptomatic the patients are.”
Observational management
At baseline, VMT was diagnosed as grade 1 in 92 eyes, grade 2 in 118 eyes and grade 3 in 20 eyes.
Spontaneous release of VMT occurred in 73 eyes after a mean observation time of 18 months.
There was a significant difference in spontaneous resolution rates between grades 1 and 3 and grades 2 and 3, with the rate of release being more frequent in eyes with more prominent changes on OCT.
Best corrected visual acuity was stable between the initial and final examinations for grades 1 and 2, but grade 3 was significantly different, with 20/85 at the presenting observation to 20/53 at the final observation.
Pars plana vitrectomy
During long-term follow-up, 10 patients underwent pars plana vitrectomy; six had macular hole and four had worsening of VMT. The macular hole was successfully closed in all six cases, and foveal fluid resolved in the four patients. Final BCVA was at least 20/40 in eight of the 10 patients.
“VMT can progress to macular hole or it can become worse or more symptomatic, and in our study we show about 4% of people eventually require surgery,” Tzu said. “So, if patients are becoming worse symptomatically or develop evidence of a full-thickness macular hole, surgery is still an option, and the people in this series generally did well when they did need surgery.”
Initial observation plus OCT
In addition to evaluating the clinical course of VMT, Tzu and colleagues augmented previous studies and classification systems by determining a timeline of when spontaneous release occurs to offer guidance on possible follow-up intervals for patients.
“One of the things we added was to estimate when [VMT] releases on OCT, and so in our study we showed it was [a median of] 8 or 9 months, and this condition can release spontaneously on its own,” he said.
With OCT imaging and the understanding of spontaneous release occurrence, initial observation may spare patients the inherent risks of surgery.
“[OCT] is absolutely critical because you can really define the extent of the disease and follow it with precision,” Tzu said. – by Kristie L. Kahl
- Reference:
- Tzu JH, et al. Ophthalmic Surg Lasers Imaging Retina. 2015;doi:10.3928/23258160-20150521-09.
- For more information:
- Jonathan H. Tzu, MD, can be reached at Bascom Palmer Eye Institute, 900 NW 17th St., Miami, FL 33136; email: jtzu2@med.miami.edu.
Disclosure: Tzu reports no relevant financial disclosures.