The Charles Schepens Lecture: Management Options for Vitreomacular Traction: Use an Individualized Approach

Abstract

Purpose: To present the management options for vitreomacular traction (VMT) and to recommend an individualized approach to treatment selection.

Design: Presented at the American Academy of Ophthalmology Annual Meeting, 2016, Chicago, October 15, 2016 (The Charles Schepens Lecture).

Participants: None.

Methods: Review of published literature and clinical trials.

Main outcome measures: Visual and anatomic outcomes of various treatment options for VMT were reviewed.

Results: The management options for VMT include pars plana vitrectomy, pneumatic vitreolysis, enzymatic vitreolysis, and observation. The surgical management using pars plana vitrectomy offers the most effective approach for VMT, but there are inherent risks and cost issues. Pneumatic vitreolysis is reported to be cost-effective and may be an anatomically successful nonsurgical option for management. Enzymatic vitreolysis with intravitreal ocriplasmin is another nonsurgical option, but both short- and long-term side effects may occur. Observation in selected patients can be associated with stable visual outcomes during long-term follow-up.

Conclusions: The final management decision should be individualized for specific patients depending on the patient's clinical findings, potential risks, probable benefits, and costs of each option.

Figure 1

Dr Charles L. Schepens.

Figure 2

Vitreomacular traction with surface retinal distortion, intraretinal cystic changes, and distortion of the ellipsoid zone on optical coherence tomography.