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The study followed the tenets of the Helsinki declaration 2013.
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The scientific committee of RIO and of the Ophthalmology department, Faculty of Medicine, Cairo University approved the study. The study was performed at the Research Institute of Ophthalmology (RIO), Giza, Egypt. This is a prospective interventional non-comparative study including patients with isolated focal VMT (≤1500µm) treated with a single injection of an expansile concentration of SF6. In the present study, we evaluated the efficacy of intravitreal injection of an expansile concentration of sulfur hexafluoride (SF6) gas for the treatment of symptomatic focal VMT syndrome. In addition, intravitreal gas injection may be a safer procedure compared to the more invasive PPV. Another treatment modality for VMT is pneumatic vitreolysis (PVL) with an intravitreal injection of an expansile concentration of gas bubble, potentially avoiding the need for vitrectomy or enzymatic vitreolysis. Although VMT is typically treated with pars plana vitrectomy (PPV) or intravitreal Ocriplasmin injection, these procedures can be invasive, require capital costs and surgical expertise as in PPV and the success rate is lower as in Ocriplasmin injection. Vitreomacular adhesion (VMA) can be divided into 2 shapes according to the pattern of adhesion: V-shaped and J-shaped, the first pattern is associated with better surgical outcomes than the latter. VMT can be classified as focal (≤1500µm) or broad (>1500µm) depending on the diameter of vitreous attachment and as concurrent or isolated based on morphologic finding on OCT images. These glial cells contribute to the contractile forces in VMT. Histopathologic examination of VMT specimens demonstrates a variety of cell types such as astrocytes, myofibroblasts and fibrocytes. The prevalence of isolated idiopathic VMT is approximately 0.6 per 100 000 of the general population. VMT can occur in isolation, or in conjunction with comorbid macular conditions, as macular hole, macular edema, and epiretinal membrane (ERM). Vitreomacular traction (VMT) is defined as posterior vitreomacular attachment with tractional distortion of the perifoveal architecture inducing visual disturbance. Vitreoretinal interface disorders refer to a spectrum of pathologic interactions between the posterior hyaloid and the underlying retinal surface, ranging from innocuous attachment to substantial disruption of retinal integrity. Further studies are needed to evaluate its indications, benefits, and risks. Pneumatic vitreolysis (PVL) with limited face-down position is a viable option for treating focal VMT with few adverse events.
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One patient developed a retinal break at upper nasal retina after two weeks of injection. The rate of release in phakic eyes was 90% (18 of 20 eyes) versus 60% in pseudophakic eyes (6 of 10 eyes). VMT release was documented on SD-OCT at an average of 3 weeks (range, 1–12 weeks). Overall, VMT release occurred in 24 of 30 eyes by the final follow-up visit (80% final release rate) furthermore, 76.9% of eyes with diabetic maculopathy and 25% of eyes with concurrent epiretinal membrane (ERM) had successful VMT release. Secondary outcome measures were changes in postoperative BCVA andCFT. Primary outcome measure was release of VMT. Postoperatively, we performed SD-OCT at one week, one month, and three months for all eyes. All eyes received single intravitreal injection of 0.3 mL of 100% SF6 gas. Pre-operatively, mean best corrected visual acuity (BCVA) was 20/125 (range 20/400–20/40).
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#Vmt medical series
This is a prospective interventional case series including 30 eyes of 29 patients with symptomatic focal VMT evident on SD-OCT. To evaluate the efficacy of single intravitreal injection of an expansile concentration of sulphur hexafluoride gas (SF6) in treating patients with symptomatic focal vitreomacular traction (VMT) documented by spectral domain optical coherence tomography (SD-OCT) preoperatively.