OCT-guided hyaloid release for vitreomacular traction syndrome

Abstract

Purpose: To evaluate the usefulness of OCT retinal mapping in determining the configuration of a vitreomacular adhesion and selecting a meridian for entry into the subhyaloid space in patients with vitreomacular traction syndrome.

Methods: Six consecutive patients (6 eyes) with vitreomacular traction syndrome underwent vitrectomy with peeling of posterior hyaloid. Ocular coherence tomography (OCT) retinal mapping was performed preoperatively. Access to the subhyaloid space was made by creating an opening with a 25 gauge needle at a location where the detached posterior hyaloid membrane was farthest from the retinal surface. The location was selected based on six preoperative meridional OCT scans. The posterior hyaloid was then gently peeled off in a circular fashion around the fovea with a micropick. Visual acuity and foveal thicknesses were measured before the operation and 3 months afterwards.

Results: After the operation, visual acuity improved and central macular thicknesses were reduced significantly in all six patients. The best corrected visual acuity improved from 0.4 to 0.75 with a mean increase by 3.5 lines on a Snellen chart 3 months after the operation. The mean foveal thickness was reduced from 406 micrometer to 241 micrometer. The restoration of foveal pit was observed in five patients. Neither intraoperative nor postoperative complications were observed during the follow up period.

Conclusions: An OCT retinal mapping program is a valuable diagnostic tool in understanding the configuration of vitreomacular adhesion and planning the surgical approach for operating on vitreomacular traction syndrome.

Fig. 1

Localization of the retinal opening site with OCT retinal mapping. (A) Preoperative OCT retinal mapping of patient 4 (50-year-old female, left eye) contains radial spoke pattern of six scans 6 mm long, centered on the patient's fixation point. (B) Cross-sectional optical coherence tomograms obtained from the corresponding six radial scans. A blue arrow points to the site with posterior hyaloid detachment farthest from the retina. (C) During the operation, two imaginary circles the size of the optic nerve head are drawn to approximate a length of 3 mm. The blue arrow within the second circle points to the opening site for an access to subhyaloid space. (D) Three months after the surgery, the foveal detachment has resolved and the foveal pit is restored. The OCT is taken at 60 degree plane.

Fig. 2

Peeling of the posterior hyaloid membrane. (A) Creating an opening at the preoperatively located site with a 25 g needle. Since the posterior hyaloid membrane's detachment is farthest from the retina as shown on preoperative OCT retinal mapping,the procedure can be performed safely and effectively. (B) Peeling of the posterior hyaloid membrane with a micropick in a circular fashion around the macula.