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Pneumatic vitreolysis resolves focal vitreomacular traction

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COLORADO SPRINGS, Colo. — Pneumatic vitreolysis with limited face-down positioning appears to be a viable treatment option for resolving focal vitreomacular traction and closing select stage 2 macular holes, a speaker here said.

According to a study presented by Clement Chan, MD, FACS, at the American Ophthalmological Society meeting, there has been a resurgence of interest in the use of pneumatic vitreolysis for treating vitreomacular traction, mostly because of limitations in the success rate, cost and potential side effects found with use of Jetrea (ocriplasmin, ThromboGenics) for this purpose.

Clement Chan

In a consecutive series of 35 eyes of 34 patients with symptomatic vitreomacular traction that underwent pneumatic vitreolysis, complete posterior vitreous detachment (PVD) developed in 97% at a mean of 3.6 weeks after C₃F₈ gas injection.

“Our technique of pneumatic vitreolysis included injection of 0.3 cc of C₃F₈ gas after informed consent and sterile prepping and subconjunctival injection of anesthesia in an outpatient clinic,” Chan said. Partial face-down positioning was required for patients with stage 2 macular hole.

Looking at eyes with vitreomacular traction only, PVD occurred in 20 of 24 eyes (83%). In all 11 eyes with stage 2 macular hole ( 250 µm), PVD developed, with macular hole closure occurring in eight of those eyes (73%).

Median best corrected visual acuity was 20/50 preoperatively and 20/30 at last visit. Mean follow-up was 11.7 months.

“How does this work? We don’t really know,” Chan said. “We theorize that the gas bubble may destabilize the vitreous integrity by accentuating liquefaction, and the cortical vitreous collapses during the absorption phase of the bubble, leading to PVD. Perhaps the long-acting bubble serves as a cushion and a more gentle PVD.”

Chan said the technique appears to work best when there is limited focal vitreomacular traction of 1 to 2 disc areas, when there is a lack of extensive vitreomacular adhesion and traction, and when there is lack of thick cellophane membrane. – by Patricia Nale, ELS

Reference:

Chan C. Management of focal vitreoretinal traction with pneumatic vitreolysis. Presented at: American Ophthalmological Society meeting; May 19-22, 2016; Colorado Springs, Colo.

Disclosure: Chan reports no relevant financial disclosures.