Speaker suggests observation to manage vitreomacular adhesion
TORONTO — The clinical course of patients with vitreomacular adhesions managed by initial observation is generally favorable, a speaker here said.
“Overall, 32% of study eyes had spontaneous release of the vitreomacular adhesion,” Harry Flynn, MD, said at the American Society of Retina Specialists meeting.
Flynn reported a noncomparative case series of patients with vitreomacular adhesion noted on spectral-domain optical coherence tomography (SD-OCT) and selected for observational management by individual physicians.
According to the SD-OCT grading system used in the study, grade 1 was incomplete separation of cortical vitreous with foveal attachment; grade 2 was the same as grade 1 with the addition of an intraretinal cyst, cleft or schisis; and grade 3 was the same as grade 2 with the addition of neurosensory elevation of the retina from the retinal pigment epithelium with early subretinal fluid.
At first exam, mean visual acuity of 43 eyes in the grade 1 category was 20/32, which remained the same at the last exam. Fifty-six eyes in the grade 2 category were 20/40 at first exam and 20/42 at last exam. Mean visual acuity of the seven grade 3 eyes improved from 20/54 to 20/44. Flynn accounted for the improvement in grade 3 eyes by saying two of the eyes had undergone vitreoretinal surgery, and three eyes improved after spontaneous separation.
“Visual acuity between the initial and last examination was usually the same,” Flynn said. “There’s a high rate – 32% – of spontaneous release of vitreomacular adhesion and a low rate of progression to a more severe anatomic configuration. Only 4% of eyes in this study after 23 months of follow-up underwent vitrectomy,” he said.
Flynn said that the SD-OCT grading scale used in the study could be useful in managing patients with this diagnosis.