Eyes with vitreomacular traction (VMT) without macular hole (MH) have significant external limiting membrane (ELM) disruption, ellipsoid zone (EZ) disruption, and subretinal fluid (SRF), according to a study in the British Journal of Ophthalmology. The report also shows that VMT release is usually associated with outer retinal recovery and a related improvement in visual acuity. The researchers note that ELM typically occurs before EZ recovery and SRF resolution following VMT release. 

Investigators analyzed 144 eyes with VMT without MH. In total, 96 eyes (66.7%) were randomly assigned to ocriplasmin and 48 eyes (33.3%) were randomly assigned to sham. The researchers evaluated eyes for the presence, course and clinical effect of ELM disruption, EZ disruption and SRF on optical coherence tomography (OCT). They found that ELM disruption, EZ disruption and SRF were present in 32.6%, 52.2%, and 45.8% of ocriplasmin-treated eyes, respectively, and 39.6%, 42.6%, and 37.5% of sham-treated eyes, respectively at baseline. 

The study also found that VMT resolution is associated with resolution of ELM, EZ disruption and SRF. At 17 months or later, only a few eyes experienced persistent ELM disruption, EZ disruption and SRF following medical or surgical VMT resolution. The resolution of ELM disruption, EZ disruption and/or SRF is associated with an improvement in visual acuity from baseline, according to the report. The analysis also showed that ELM recovery usually preceded EZ recovery and SRF resolution after VMT release.  


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The study may have been limited by the small sample size. “While data were collected prospectively over 24 months of follow-up, the duration of VMT and ELM disruption, EZ disruption and presence of SRF was variable. Additionally, the relative impact of ocriplasmin and VMT on ELM disruption, EZ disruption and/or presence of SRF may have been hard to tease apart,” according to the investigators. “Presence of foveal outer retinal abnormalities in eyes with VMT should prompt intervention as normalization of foveal outer retinal anatomy may not occur if treatment is delayed.” 

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.  

Reference

Thomas AS, Duchateau L, Kozma-Wiebe P, Jaffe G. Resolution of outer retinal abnormalities in eyes with vitreomacular traction without macular hole in the OASIS trial. Br J Ophthalmol. Published online March 14, 2022. doi:10.1136/bjophthalmol-2021-319500