title: Rate and timing of spontaneous resolution in a vitreomacular traction group: should the role of watchful waiting be re-evaluated as an alternative to ocriplasmin therapy?
abstract: BACKGROUND
  The incidence of spontaneous resolution of vitreomacular traction (VMT) is low in studies of Ocriplasmin that have had a limited follow-up. Previous studies did not look for morphological parameters in the natural history using spectral-domain ocular coherence tomography (SD-OCT) imaging. The purpose of this study was to investigate how often and when spontaneous VMT resolution occurs in candidates for Ocriplasmin therapy.
  
  
  METHODS
  The study is a retrospective chart review of patients who would have high chances of a benefit by an Ocriplasmin injection, without epiretinal membrane or vitreomacular adhesion of 1500 µm or more on SD-OCT. Main outcome measures were the frequency of complete VMT resolution and the best corrected visual acuity seen in the natural history.
  
  
  RESULTS
  Out of the 46 patients that were included after screening 889 SD-OCT images, 20 were found to exhibit spontaneous resolution during the follow-up period (median: 594 days, 95% CI 567 to 719 days), the majority after 6-12 months of observation (95% CI 266 to 617 days). The group with spontaneous VMT resolution and a mean improvement of one line in best corrected visual acuity included a few patients losing vision by macular hole formation. In the absence of resolution, patients lost on average one early treatment diabetic retinopathy study letter per year. Younger age was found to increase the chance of spontaneous resolution.
  
  
  CONCLUSIONS
  A shorter follow-up might underestimate the incidence of spontaneous VMT resolution as the functional outcome of watchful waiting. The likelihood of resolution does not seem to decrease after 12 months.
authors.affiliation: Centre for Ophthalmology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany.
authors.forename: Spyridon
authors.initials: S
authors.lastname: Dimopoulos
authors.affiliation: Centre for Ophthalmology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany.
authors.forename: Karl-Ulrich
authors.initials: KU
authors.lastname: Bartz-Schmidt
authors.affiliation: Centre for Ophthalmology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany.
authors.forename: Faik
authors.initials: F
authors.lastname: Gelisken
authors.affiliation: Centre for Ophthalmology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany.
authors.forename: Kai
authors.initials: K
authors.lastname: Januschowski
authors.affiliation: Centre for Ophthalmology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany.
authors.forename: Focke
authors.initials: F
authors.lastname: Ziemssen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005341:Fibrinolysin / Q000627:therapeutic use*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000627:therapeutic use*; D012075:Remission, Spontaneous; D012164:Retinal Diseases / Q000188:drug therapy / Q000503:physiopathology*; D012189:Retrospective Studies; D013997:Time Factors; D000267:Tissue Adhesions; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D014822:Vitreous Body / Q000473:pathology; D020255:Vitreous Detachment / Q000188:drug therapy / Q000503:physiopathology*; D057832:Watchful Waiting / Q000379:methods*
chemical_list: D005343:Fibrinolytic Agents; D010446:Peptide Fragments; C054561:microplasmin; D005341:Fibrinolysin
keywords: Macula; Retina; Vitreous