Natural Course of Vitreomacular Traction in Eyes With Diabetic Retinopathy and Factors Associated With Spontaneous Release

Abstract

The aim of this study was to determine the natural course of vitreomacular traction (VMT) in patients with diabetic retinopathy and to evaluate the factors associated with VMT relief.Methods: Seventy-four eyes of 65 patients with VMT accompanying diabetic retinopathy were evaluated retrospectively. The presence of intravitreal injection and the presence of panretinal photocoagulation were obtained from the medical records of the patients. Spontaneous release of VMT, the horizontal length of vitreomacular traction, the presence of hyperreflective retinal spots, the presence of the epiretinal membrane, and the grade of VMT were evaluated from the spectral-domain optical coherence tomography images. Factors associated with the spontaneous release of VMT were evaluated by logistic regression analysis.Results: Spontaneous release was observed in 28 eyes (37.8%). The horizontal length of VMT was lower in the release of the VMT group compared with the persistent VMT group (P = 0.03). The persistent VMT group had a higher rate of hyperreflective retinal spots and epiretinal membrane compared with the release of the VMT group (respectively; P = 0.003 and P = 0.031). No statistically significant difference was observed between the release of VMT and persistent VMT groups in terms of intravitreal injection and panretinal photocoagulation treatment (respectively; P = 0.938 and P = 0.36). The absence of hyperreflective retinal spots was the most important prognostic factor for the spontaneous release of VMT (P = 0.029).Conclusion: Spontaneous release of VMT observed higher rates of patients without hyperreflective retinal spots, epiretinal membrane, and patients with lower horizontal length of VMT.

Predictive Factors of Spontaneous Release of Vitreomacular Traction

“…Almeida et al 5 found this to be significant. Garip et al 14 did not observe a significant difference in IVI between their released and persistent VMT groups, but did find spontaneous release occurred in a shorter period in cases with IVI. Our meta-analysis showed no significant difference in previous IVI between the released and persistent VMT groups.…”

“…Eighteen studies underwent full text review, and, ultimately, 12 were included (Figure 1; Table 1). [4][5][6][9][10][11][12][13][14][15][16][17] Overall, 934 eyes were included; 104 eyes came from prospective studies (n = 3 studies) and 830 from retrospective studies (n = 9). Mean age was 70.0 years old, 37.2% of patients were men, and mean follow-up was 22.0 months.…”

“…Eighteen studies underwent full text review, and, ultimately, 12 were included (Figure 1; Table 1). 4–6,9–17…”

“…Codenotti et al 11 used a novel OCT model in a retrospective study of 26 eyes and found mean vitreomacular interface area was significantly smaller in the group with spontaneous release with an area below 101,002 µ m 2 being the threshold indicating increased likelihood of resolution. Garip et al 14 retrospectively studied 74 eyes and found absence of hyperreflective retinal spots, which are believed to be aggregates of microglial cells associated with inflammation, was the strongest predictive factor for spontaneous release.…”

“…4,14,17 Spontaneous release may be less likely in patients with concomitant ERM because there is more fibrocellular tissue at the vitreoretinal interface, resulting in closer and stronger adherence. 4,14,17 Thus, eyes with ERM may be suboptimal candidates for observation. Furthermore, ERM itself may be an indication for intervention, suggesting observation may be inappropriate.…”