Spectral domain OCT image of VMT associated with mild DME.
Of note, the macula remained thickened (CMT 325 μm) and cystic (fig. Six months later, the patient returned and had developed spontaneous resolution of VMT and an improved visual acuity of 6/6 OS with no interval interventions. Because his edema and visual acuity were stable, observation was recommended.
The OCT also demonstrated inner retinal tenting, confirming VMT OS (fig. His visual acuity in OS was 6/9, and he had macular thickening diagnosed as mild diffuse DME. Additionally, the patient had persistent DME OU with stable vision after focal laser photocoagulation and anti-vascular endothelial growth factor. Case PresentationĬase 1 is a 63-year-old white male, previously treated for proliferative diabetic retinopathy with panretinal photocoagulation.
#VMT MEDICAL FULL#
This study was conducted in full adherence to the Declaration of Helsinki and all federal and state laws. As both surgical and pharmacologic intervention have been suggested to treat DME in the setting of VMT, we feel that a clarification of the nomenclature and reporting of these cases of natural history may be useful in more fully understanding the complex decision-making involved when determining whether to treat this subset of patients. In this report, we describe the spontaneous resolution of VMT in two eyes of 2 patients with DME. Nonetheless, it is not clear what the role of pharmacological enzymatic vitreolysis will play in cases of VMA associated with macular disease like DME. Ocriplasmin is primarily used for the treatment of stage 2 MHs less than 400 μm.
Intravitreal ocriplasmin (Jetrea®) was approved in the USA in October 2012 to relieve VMA causing VMT and MH, and just recently, in August 2013, has been approved in Canada based on several clinical trials. We have found that for purposes of defining inclusion criteria for studies and general thresholds of disease definition, these standards may be useful, although they represent a starting point in our quantification of image-disorder correlation. Recent attempts to define photographic standards relating to the OCT abnormalities associated with VMA that may result in VMT has been proposed by Simpson et al. Symptoms of retinal distortion in the absence of VMT are usually due to other disorders, most commonly ERMs or subretinal or intraretinal fluid. Such changes include widespread to point-like macular retinal thickening (including an increase in intraretinal fluid), tenting of the inner limiting membrane and/or other inner retinal tissues, and/or focal tractional macular detachment(s). VMT may be confirmed only when the vitreous tensional force is sufficient to result in characteristic retinal or vitreous structural changes, which is best identified on optical coherence tomography (OCT). īoth VMT and its pathologic cousin sVMA require evidence of vitreomacular attachment and vitreous tension moreover, in the case of sVMA, vision loss typically manifested as blurring, reduced acuity, or metamorphopsia is present. Isolated VMT with decreased vision loss - termed VMT syndrome - occurs in isolation without associated macular disease however, it is recognized that symptomatic vitreomacular adhesion (sVMA) may be associated with other conditions such as macular hole (MH), epiretinal membrane (ERM), age-related macular degeneration (AMD), diabetic macular edema (DME), or retinal vein occlusion (RVO). VMT may be found with increased incidence in disorders that involve disordered vitreoretinal adhesion such as diabetic retinopathy or foreshortening of the vitreous as partial vitreous detachment. Furthermore, the nomenclature used to describe disorders of this interface may be confusing and subject to imprecise characterization. Despite recent advances, however, the nature and character of the vitreoretinal junction remains incompletely understood. Vitreomacular traction (VMT) or VMT syndrome is an increasingly recognized disorder that has attracted recent attention as a target for both surgical and pharmacologic treatments.
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