title: ANATOMICAL AND FUNCTIONAL OUTCOMES OF SYMPTOMATIC IDIOPATHIC VITREOMACULAR TRACTION: A Natural History Study From the Pan American Collaborative Retina Study Group.
abstract: OBJECTIVE
  To describe the natural history of eyes with symptomatic idiopathic vitreomacular traction (VMT).
  
  
  METHODS
  Retrospective multicenter study of 168 eyes with spectral-domain optical coherence tomography (SD-OCT) findings consistent with idiopathic VMT. All eyes were graded according to SD-OCT findings. Grade 1 was defined as incomplete cortical vitreous separation with foveal attachment. Grade 2 was defined as Grade 1 plus intraretinal cysts or clefts. Grade 3 was defined as Grade 2 plus a foveal detachment. All patients were followed for at least 6 months.
  
  
  RESULTS
  There were 168 patients (51 men) with a mean age of 68.8 ± 10.7 years. Patients were followed for a mean of 22.7 ± 20.1 months. The mean duration of symptoms before the initial presentation was 3.65 ± 5.42 months. At baseline, 72 eyes had Grade 1, 74 eyes had Grade 2, and 22 eyes had Grade 3 SD-OCT findings. Over the follow-up period, 36 eyes (21.4%) had spontaneous resolution of the VMT with normalization of the foveal anatomy. The mean time to resolution was 12.3 ± 12.6 months. An unfavorable anatomical outcome occurred in 7.7% (13 of 168) of the eyes, with 6 eyes developing a lamellar macular hole and 7 eyes developing a full-thickness macular hole. This occurred at a mean of 10.3 ± 10.7 months after the presentation. Subgroup analysis based on baseline SD-OCT grade showed that 4.1% (3 of 73) of Grade 1 eyes compared with 6.8% (5 of 74) of Grade 2 eyes, and 23.8% (5 of 21) of Grade 3 eyes developed a full-thickness macular hole or lamellar macular hole (P = 0.0109, chi-square test). In the remaining 119 eyes, at the last follow-up, 65 eyes had Grade 1, 42 eyes had Grade 2, and 12 eyes had Grade 3 VMT. On average, the best-corrected visual acuity improved from 0.40 ± 0.35 logarithm of the minimum angle of resolution (Snellen, 20/50) at baseline to 0.35 ± 0.36 logarithm of the minimum angle of resolution (Snellen, 20/45; P = 0.0372), and the mean central macular thickness improved from 350 ± 132 μm to 323 ± 121 μm.
  
  
  CONCLUSIONS
  Spontaneous resolution of VMT occurred in 21.4% (36 of 168) of eyes after a mean follow-up of 11.4 ± 12.6 months. An unfavorable anatomical outcome occurred in 7.7% (13 of 168) of eyes. The baseline SD-OCT grade may predict the progression to full-thickness macular hole.
authors.affiliation: *Macula, Vitreous and Retina Associates of Costa Rica, San José, Costa Rica; †University of Buenos Aires, Argentina; ‡University of Puerto Rico, San Juan, Puerto Rico; §The King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia; ¶Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland; **Retina Department, Ramón y Cajal University Hospital, Madrid, Spain; ††VISSUM Madrid, Madrid, Spain; ‡‡National Ophthalmological Foundation, Rosario University, Bogota, Colombia; §§Centro Caracas Ophthalmologic Clinic, Caracas, Venezuela; ¶¶Conde Valenciana Foundation, Mexico City, Mexico; ***OFTALMOS University of Buenos Aires, Buenos Aires, Argentina; †††La Fe Hospital, University of Valencia, Valencia, Spain; ‡‡‡Ricardo Palma Clinic, Lima, Peru; §§§Association for Blindness Prevention in Mexico, Mexico City, Mexico; ¶¶¶Retina and Vitreous Unit, Department of Ophthalmology, Moises Broggi Hospital, Barcelona, Spain; ****Department of Ophthalmology, Vision Institute, Federal University of Sao Paulo, Sao Paulo, Brazil; ††††University of Colorado, School of Medicine, Denver, Colorado; ‡‡‡‡Department of Ophthalmology, Federal University of Goias, Goiânia, Brazil; and §§§§LV Prasad Eye Institute, Hyderabad, India.
authors.forename: Lihteh
authors.initials: L
authors.lastname: Wu
authors.forename: Marcelo
authors.initials: M
authors.lastname: Zas
authors.forename: Maria H
authors.initials: MH
authors.lastname: Berrocal
authors.forename: J Fernando
authors.initials: JF
authors.lastname: Arevalo
authors.forename: Marta
authors.initials: M
authors.lastname: Figueroa
authors.forename: Francisco
authors.initials: F
authors.lastname: Rodriguez
authors.forename: Martin
authors.initials: M
authors.lastname: Serrano
authors.forename: Federico
authors.initials: F
authors.lastname: Graue
authors.forename: Arturo
authors.initials: A
authors.lastname: Alezzandrini
authors.forename: Roberto
authors.initials: R
authors.lastname: Gallego-Pinazo
authors.forename: José A
authors.initials: JA
authors.lastname: Roca
authors.forename: Matias
authors.initials: M
authors.lastname: Iglicki
authors.forename: José
authors.initials: J
authors.lastname: Dalma-Weishauz
authors.forename: Igor
authors.initials: I
authors.lastname: Kozak
authors.forename: Alberto
authors.initials: A
authors.lastname: Collado
authors.forename: Josep
authors.initials: J
authors.lastname: Badal
authors.forename: Mauricio
authors.initials: M
authors.lastname: Maia
authors.forename: Guillermo
authors.initials: G
authors.lastname: Salcedo-Villanueva
authors.forename: Hugo
authors.initials: H
authors.lastname: Quiroz-Mercado
authors.forename: Jans
authors.initials: J
authors.lastname: Fromow-Guerra
authors.forename: David
authors.initials: D
authors.lastname: Lozano-Rechy
authors.forename: Marcos
authors.initials: M
authors.lastname: Avila
authors.forename: Jay
authors.initials: J
authors.lastname: Chhablani
mesh_terms: D000368:Aged; D005260:Female; D005341:Fibrinolysin / Q000627:therapeutic use; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D010446:Peptide Fragments / Q000627:therapeutic use; D012075:Remission, Spontaneous; D012164:Retinal Diseases / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D012167:Retinal Perforations / Q000175:diagnosis / Q000188:drug therapy; D012189:Retrospective Studies; D066167:Slit Lamp; D000267:Tissue Adhesions / Q000175:diagnosis; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy; D020255:Vitreous Detachment / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology
chemical_list: D005343:Fibrinolytic Agents; D010446:Peptide Fragments; C054561:microplasmin; D005341:Fibrinolysin