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A review of current management of vitreomacular traction and macular hole.

García-Layana A, García-Arumí J, Ruiz-Moreno JM, Arias-Barquet L, Cabrera-López F, Figueroa MS - J Ophthalmol (2015)

Bottom Line: The paper presents a review of the sequence of events of posterior vitreous detachment (PVD), vitreomacular adhesion (VMA), vitreomacular traction (VMT), and macular hole (MH) from their pathophysiological aspects, clinical features, diagnostic implications, and current management strategies.A treatment algorithm to be used in clinical practice in patients with VMA, VMT, and MH based on the presence of symptoms, visual acuity, associated epiretinal membrane, and width of the vitreous attachment is presented.Observation, pharmacologic vitreolysis with ocriplasmin, and surgical treatment are positioned as treatment options in the different steps of the therapeutic algorithm, with clear indications of the paths to be followed according to the initial presenting manifestations and the patient's clinical course.

View Article: PubMed Central - PubMed

Affiliation: Clínica Universidad de Navarra, Avenida de Pío XII 36, 31008 Pamplona, Spain.

ABSTRACT
The paper presents a review of the sequence of events of posterior vitreous detachment (PVD), vitreomacular adhesion (VMA), vitreomacular traction (VMT), and macular hole (MH) from their pathophysiological aspects, clinical features, diagnostic implications, and current management strategies. A treatment algorithm to be used in clinical practice in patients with VMA, VMT, and MH based on the presence of symptoms, visual acuity, associated epiretinal membrane, and width of the vitreous attachment is presented. Observation, pharmacologic vitreolysis with ocriplasmin, and surgical treatment are positioned as treatment options in the different steps of the therapeutic algorithm, with clear indications of the paths to be followed according to the initial presenting manifestations and the patient's clinical course.

No MeSH data available.


Related in: MedlinePlus

(a) Focal VMT. The arrow points to the ellipsoid zone. (b) Release of VMT after injection of ocriplasmin. A severe disruption in the ellipsoid zone is shown (by courtesy of Dr. Peter K. Kaiser, Cleveland Clinic, Cleveland, OH, USA).
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fig3: (a) Focal VMT. The arrow points to the ellipsoid zone. (b) Release of VMT after injection of ocriplasmin. A severe disruption in the ellipsoid zone is shown (by courtesy of Dr. Peter K. Kaiser, Cleveland Clinic, Cleveland, OH, USA).

Mentions: In another study in which 17 patients were included [37], almost all the patients who responded to the treatment (7/8) had ellipsoid zone changes on the SD-OCT (Figure 3). These patients also had transient reduction of visual acuity and demonstrated subretinal fluid during the release process with almost the exact time course as the loss of the OS ellipsoid zone. The loss of the OS ellipsoid zone occurred after an average of 5 days after injection of ocriplasmin and the mean time of resolution on OCT was 29.3 days. The occurrence and resolution of subretinal fluid occurred at an average of 4.8 days and 30 days after injection, respectively. However, in a retrospective review of 62 eyes with symptomatic VMA treated with ocriplasmin, subretinal fluid appeared in 37% of cases, with persistence of fluid in 30% of cases after 5 months of follow-up [42]. Other studies have also shown resolution of the ellipsoid zone changes in most patients within weeks or months after ocriplasmin injection [43, 44].


A review of current management of vitreomacular traction and macular hole.

García-Layana A, García-Arumí J, Ruiz-Moreno JM, Arias-Barquet L, Cabrera-López F, Figueroa MS - J Ophthalmol (2015)

(a) Focal VMT. The arrow points to the ellipsoid zone. (b) Release of VMT after injection of ocriplasmin. A severe disruption in the ellipsoid zone is shown (by courtesy of Dr. Peter K. Kaiser, Cleveland Clinic, Cleveland, OH, USA).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4363823&req=5

fig3: (a) Focal VMT. The arrow points to the ellipsoid zone. (b) Release of VMT after injection of ocriplasmin. A severe disruption in the ellipsoid zone is shown (by courtesy of Dr. Peter K. Kaiser, Cleveland Clinic, Cleveland, OH, USA).
Mentions: In another study in which 17 patients were included [37], almost all the patients who responded to the treatment (7/8) had ellipsoid zone changes on the SD-OCT (Figure 3). These patients also had transient reduction of visual acuity and demonstrated subretinal fluid during the release process with almost the exact time course as the loss of the OS ellipsoid zone. The loss of the OS ellipsoid zone occurred after an average of 5 days after injection of ocriplasmin and the mean time of resolution on OCT was 29.3 days. The occurrence and resolution of subretinal fluid occurred at an average of 4.8 days and 30 days after injection, respectively. However, in a retrospective review of 62 eyes with symptomatic VMA treated with ocriplasmin, subretinal fluid appeared in 37% of cases, with persistence of fluid in 30% of cases after 5 months of follow-up [42]. Other studies have also shown resolution of the ellipsoid zone changes in most patients within weeks or months after ocriplasmin injection [43, 44].

Bottom Line: The paper presents a review of the sequence of events of posterior vitreous detachment (PVD), vitreomacular adhesion (VMA), vitreomacular traction (VMT), and macular hole (MH) from their pathophysiological aspects, clinical features, diagnostic implications, and current management strategies.A treatment algorithm to be used in clinical practice in patients with VMA, VMT, and MH based on the presence of symptoms, visual acuity, associated epiretinal membrane, and width of the vitreous attachment is presented.Observation, pharmacologic vitreolysis with ocriplasmin, and surgical treatment are positioned as treatment options in the different steps of the therapeutic algorithm, with clear indications of the paths to be followed according to the initial presenting manifestations and the patient's clinical course.

View Article: PubMed Central - PubMed

Affiliation: Clínica Universidad de Navarra, Avenida de Pío XII 36, 31008 Pamplona, Spain.

ABSTRACT
The paper presents a review of the sequence of events of posterior vitreous detachment (PVD), vitreomacular adhesion (VMA), vitreomacular traction (VMT), and macular hole (MH) from their pathophysiological aspects, clinical features, diagnostic implications, and current management strategies. A treatment algorithm to be used in clinical practice in patients with VMA, VMT, and MH based on the presence of symptoms, visual acuity, associated epiretinal membrane, and width of the vitreous attachment is presented. Observation, pharmacologic vitreolysis with ocriplasmin, and surgical treatment are positioned as treatment options in the different steps of the therapeutic algorithm, with clear indications of the paths to be followed according to the initial presenting manifestations and the patient's clinical course.

No MeSH data available.


Related in: MedlinePlus