April 21, 2017 Conference


Management of Vitreomacular Traction

Dr. Chirag Shah, Ophthalmic Consultants of Boston (Presenter)
Dr. John Miller, Mass Eye and Ear Infirmary
Speaker Session Topic
Vitreomacular traction (VMT) is an age-related change that can occur in the vitreous gel of some patients. The resulting disruption in the foveal anatomy can lead to decreased visual acuity and metamorphopsia. There are several treatment options for VMT, including vitrectomy, ocriplasmin, pneumatic vitreolysis, and even observation. Approximately 30-40% of VMT cases will resolve spontaneously without intervention. Vitrectomy is the most definitive way to treat VMT, with a 100% release rate, but requires a trip to the operating room, has higher infection rates and leads to early cataract formation. Ocriplasmin (Jetrea, ThromboGenics, Inc., Iselin, NJ) is a $4,000 FDA-approved intravitreal injection for enzymatic vitreolysis that releases VMT 26.5% of the time. It can be more successful in cases without epiretinal membrane, diabetes, or broad vitreomacular adhesion . Pneumatic vitreolysis is an office-based intraviteal injection of an expansile gas bubble, which hopes to create a posterior vitreous detachment. Authors have hypothesized that as the gas contracts vitreous syneresis is enhanced, allowing fluid to move into the pocket formed by the gas and into the subhyaloid space, gently inducing a PVD . All of the treatment options, including observation, have risk of macular hole formation and permanent vision loss. More recent literature on ocriplasmin has raised photoreceptor toxicity concerns limiting its real world application.