Pneumatic Vitreolysis Versus Pars Plana Vitrectomy in Focal Symptomatic Vitreomacular Traction Syndrome

Kumar, Vinod; Sonkar, Ragini; Verma, Saurabh; Azad, Shorya Vardhan; Chawla, Rohan; Venkatesh, Pradeep; Vohra, Rajpal; Kumar, Ajeet

doi:10.1097/iae.0000000000003456

Cited by 3 publications

(5 citation statements)

References 23 publications

(37 reference statements)

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“…Pars plana vitrectomy is now considered a golden standard for VMT treatment with favorable anatomical and visual outcomes. 2,3,10 In this study, postoperative CMT was significantly decreased from baseline, with most eyes completing the restoration of the normal foveal depression and subretinal fluid resolution. Moreover, significant visual improvement was achieved after PPV, including nearly one half improving ≥ two Snellen lines, which was consistent with the previous studies, 4,5 justifying the efficacy of surgical treatment in facilitating anatomical and visual recovery for VMT patients.…”

Section: Discussionmentioning

confidence: 52%

mentioning

confidence: 99%

“…Although pneumatic vitreolysis and intravitreal injection of ocriplasmin are less invasive, PPV is considered as the gold standard for the treatment for symptomatic VMT because of its high success rate and favorable visual improvement. 2,3 Nevertheless, the visual outcomes after PPV vary among patients. It was reported that only approximately 30% of patients could gain $ 2 Snellen lines after surgery.…”

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confidence: 99%

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Predictive factors associated with the visual prognosis after surgery for idiopathic vitreomacular traction

Qi,

Yang,

et al. 2023

Retina

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Purpose: To investigate the predictive factors for post-surgical visual prognosis in vitreomacular traction (VMT) patients. Methods: This retrospective study enrolled 31 eyes from 29 patients who underwent vitrectomy for idiopathic VMT with follow-up period ≥ 3 months. The VMT was divided into three grades based on optical coherence tomography images: grade 1 denoted partial vitreomacular separation with foveal attachment; grade 2 exhibited intraretinal cysts or cleft with grade 1 findings; grade 3 was grade 2 plus the subretinal fluid. Results: Three eyes developed a full-thickness macular hole after surgery, all of which were grade 3 patients. In the rest 28 eyes, the mean postoperative follow-up period was 23.3 ± 25.8 months. The postoperative central foveal thickness (P=0.001) and final best-corrected visual acuity (BCVA; P<0.001) were both significantly improved from baseline. Fifteen eyes (53.8%) gained ≥ two Snellen lines. Multilinear regression analysis showed that the worse the baseline BCVA (P=0.004), or the more advanced the VMT grade (P=0.049), the worse the final BCVA. Baseline BCVA was negatively associated with the postoperative visual improvement (P<0.001). Those grade 3 patients with baseline Snellen BCVA ≥ 20/40 were more likely to achieve a final Snellen BCVA ≥ 20/25 (P=0.035). Conclusion: The VMT grade is an important predictive factor for the post-surgical visual prognosis. Surgical intervention should be performed as early as possible for grade 3 patients to prevent further disease progression and maximize the post-surgical visual benefit.

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Section: Discussionmentioning

confidence: 52%

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confidence: 99%

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confidence: 99%

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Predictive factors associated with the visual prognosis after surgery for idiopathic vitreomacular traction

Qi,

Yang,

et al. 2023

Retina

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“…of macular holes Success rate of macular hole closure Follow-up period Total no. of diagnosed VMT cases VMT release Kumar et al [ 29 ] Prospective PV – 15 63.8 ± 8.38 0.80 ± 0.26 0.70 ± 0.49 (20/100 SE) 15 4 (27%) 3 months 15 12 (80%) PPV – 15 68.33 ± 8.19 0.904 ± 0.44 0.47 ± 0.26 (20/59 SE) 15 15 (100%) 3 months 15 15 (100%) Alreshaid et al [ 30 ] Retrospective PPV – 11 Not reported 0.81 ± 0.24 0.64 ± 0.26 – – 10.27 ± 4.63 months 11 11 (100%) Ocriplasmin – 8 Not reported 0.53 ± 0.29 0.52 ± 0.29 N/A N/A 3.87 ± 2.66 8 5 (62.5%) Anderson et al [ 21 ] Prospective PPV – 5 …”

Section: Resultsmentioning

confidence: 99%

“…There was no significant difference (risk ratio = 0.87, 95% CI 0.73–1.03, p = 0.11) in the VMT release rate between the two groups in terms of therapeutic efficacy (Fig. 12 ); however, only one study [ 29 ] compared the MH closure rate and showed that PPV had a higher rate of MH closure (risk ratio = 3.44, 95% CI 1.57, 7.58, p = 0.002), as shown in the funnel plot in Fig. 13 .…”

Section: Resultsmentioning

confidence: 99%

Pneumatic vitreolysis versus vitrectomy for the treatment of vitreomacular traction syndrome and macular holes: complication analysis and systematic review with meta-analysis of functional outcomes

Quiroz-Gonzalez

Lima-Gómez

2023

Int J Retin Vitr

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Background We conducted a systematic review to compare the effects of pneumatic vitreolysis (PV), enzymatic vitreolysis (EVL) with ocriplasmin, and pars plana vitrectomy (PPV) on vitreomacular traction (VMT) syndrome and macular holes (MHs) to assess their efficacy as treatment options. Methods Databases, including PubMed, ClinicalTrials.gov (www.clinicaltrials.gov), the Cochrane Central Register of Controlled Trials (CENTRAL)—including the Cochrane Eyes and Vision Group Trials Register (The Cochrane Library 2013, Issue 2)—, Ovid MEDLINE, and EMBASE (January 2000–October 2022), were searched to identify studies comparing the outcomes of PV versus PPV, PPV versus ocriplasmin and ocriplasmin versus PV. RevMan 5.1 was used for the meta-analysis of the studies. Results Among the 89 studies, 79 were considered eligible for qualitative analysis, and 10 quantitative studies were subjected to meta-analysis. PPV resulted in better postoperative visual acuity improvement than ocriplasmin (standardized mean deviation (SMD) = 0.38, 95% CI 0.03–0.73, p = 0.0003). PV resulted in no significant difference in visual improvement compared with PPV (SMD = − 0.15, 95% CI − 0.47 to 0.16, p = 0.35). PPV was significantly more effective in terms of the VMT release rate (risk ratio = 0.48, 95% CI 0.38–0.62, p = 0.00001) and MH closure rate (risk ratio = 0.49, 95% CI 0.30–0.81, p = 0.006) than ocriplasmin. PV was more effective than ocriplasmin in terms of the VMT release rate (risk ratio = 0.49, 95% CI 0.35–0.70, p = 0.0001). Qualitative analysis showed MH closure rates of 46%, 47.8%, and 95% and VMT releases rates of 46%, 68% and 100% after ocriplasmin, PV, and PPV treatments, respectively. Adverse events and postoperative complications occurring after treatment have also been documented in these studies. Conclusion PPV appears to be the most promising option for MH closure and VMT release, with fewer serious complications than EVL or PV. However, given the limited number of studies comparing these treatments, further research is needed to establish the superiority of PPV over the other options.

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Update zur Behandlungsstrategie bei vitreomakulärer Traktion und Makulaforamen: eine Umfrage unter Retinologen in Deutschland

Vogt,

Haritoglou,

Nicoletti

et al. 2024

Ophthalmologie

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Pneumatic Vitreolysis Versus Pars Plana Vitrectomy in Focal Symptomatic Vitreomacular Traction Syndrome

Cited by 3 publications

References 23 publications

Predictive factors associated with the visual prognosis after surgery for idiopathic vitreomacular traction

Predictive factors associated with the visual prognosis after surgery for idiopathic vitreomacular traction

Pneumatic vitreolysis versus vitrectomy for the treatment of vitreomacular traction syndrome and macular holes: complication analysis and systematic review with meta-analysis of functional outcomes

Update zur Behandlungsstrategie bei vitreomakulärer Traktion und Makulaforamen: eine Umfrage unter Retinologen in Deutschland

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