ELECTRONIC MEDICAL RECORD DATABASE STUDY OF VITRECTOMY AND OBSERVATION FOR VITREOMACULAR TRACTION.

PURPOSE: To audit the natural history of vitreomacular traction, and the risks and benefits of surgery.

METHODS: Database study of 1,254 patients (1,399 eyes) with vitreomacular traction from 16 UK vitreoretinal units.

RESULTS: The median age was 75 years, with 36.2% of patients diagnosed as diabetic. In 986 (70.5%) eyes managed conservatively, the median presenting logarithm of the minimum angle of resolution visual acuity of 0.30 (Snellen 20/40) was unchanged over follow-up. Of 413 eyes (29.5%) that required pars plana vitrectomy, the median preoperative visual acuity improved from 0.60 to 0.50 (20/80-20/63), 6 months to 12 months after surgery, with 33% gaining at least 0.3 units (approximately 2 Snellen lines). Vitrectomy was combined with internal limiting membrane peel in 43.8%, epiretinal membrane peel in 42.4%, gas/air tamponade in 46.2%, and cataract surgery in 27.9%. One or more intraoperative complications occurred in 12.6%; most commonly retinal breaks (8.0%), retinal trauma (1.9%), and retinal hemorrhage (1.0%). Postoperative retinal detachment occurred in 2.7% and macular hole in 2.2%. The 1, 2, and 3 year rates of postvitrectomy cataract surgery were 28.2%, 38.2%, and 42.7%, respectively.

CONCLUSION: Many eyes with vitreomacular traction have stable visual acuity. Those progressing to vitrectomy have relatively modest visual acuity gains, and complications are not infrequent.