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

Abstract

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.