| Objective:1 To observe the natural outcomes in different types of patients with vitreomacular traction syndrome(VTS), thus providing a basis for clinical interventions.2 To observe the macular microstructure and the prognosis of visual function in different types of patients with VTS.Methods: 1 Research objects: Fifty cases of VTS patients(52 affected eyes) admitted to the Ophthalmology Department of the Second Hospital of Hebei Medical University from February 2013 to December 2014 were collected. Twenty-one cases(23 eyes) that did not undergo surgery and required for follow-up observation were divided into the observation group; 29 cases(29 eyes) that agreed to accept surgery were divided into the surgery group. Standard three-port pars plana vitrectomy(PPV) and internal limiting membrane peeling(ILMP) combined with intraocular pneumatic retinopexy were performed in all patients from the surgery group. 2 Study typing: According to the adhesion morphology of vitreous and macular indicated by the examination of spectral-domain optical coherence tomography(SD-OCT), VTS patients were divided into three types: "V-type"(i.e., the vitreous cortex in the central fovea of macula and the retina were adhered punctately with an adherence diameter of less than or equal to 300um; the detachment was located on both sides of nasal and temporal), "U-type"(i.e., the vitreous cortex in the central fovea of macula and the retina were adhered in a form of platform with an adherence diameter of greater than 300um; the detachment was located on both sides of nasal and temporal) and "J-type"(i.e., the vitreous cortex in the central fovea of macula and the retina were adhered and the detachment was located on nasal or temporal; the adherent part was accompanied with or without hole). 3 Research focus: 3.1 The observation group: The total spontaneous release rate and the spontaneous release rate of each type within 12 months of follow-up were compared between "V-type", "U-type" and "J-type"; the changes in best corrected visual acuity(BCVA), central foveal thickness(CFT) and macular edema(ME) at the first visit and the last follow-up were compared between various types of patients with spontaneous resolution and patients without spontaneous resolution. 3.2 The operation group: The changes in BCVA, CFT, ME and b-wave amplitude were compared between "V-type", "U-type" and "J-type" before surgery as well as at 1, 3 and 6 months after surgery.Results: 1 The observation group: 1.1 Spontaneous resolution rate: The overall rate was 17.4% with 25% for "V-type", 14.3% for "U-type" and 0 for "J-type". The comparison of the incidences of macular traction spontaneous resolution between different types showed statistical significance(P<0.05). 1.2 Best corrected visual acuity: For "V-type" patients with spontaneous resolution, it was 0.57±0.38 at the first visit and 0.13±0.12 at the last follow-up, indicating no statistical significance difference(t=1.552, P=0.268>0.05). For patients without spontaneous resolution, it was 0.38±0.33 at the first visit and 0.38±0.26 at the last follow-up, indicating no statistical significance difference(t=0.164, P=0.873>0.05). For "U-type" patients with spontaneous resolution, it was 0.6 at the first visit and 0.2 at the last follow-up, suggesting a significant improvement. However, the statistical analysis could not be carried out since the sample size only contained 1 case. For patients without spontaneous resolution, it was 0.40±0.21 at the first visit and 0.62±0.33 at the last follow-up, suggesting a statistically significant difference(t=3.081, P=0.027<0.05). 1.3 Central foveal thickness: For "V-type" patients, it was 581.00±387.47 at the first visit and 187.33±7.02 at the last follow-up, indicating no statistical significance difference(t=1.763, P=0.220>0.05). For patients without spontaneous resolution, it was 382.67±167.14 at the first diagnosis and 402.56±164.86 at the last follow-up, indicating no statistical significance difference(t=1.942, P=0.088>0.05). For "U-type" patients with spontaneous resolution, it was 542 um at the first visit and 214 um at the last follow-up, suggesting a significant improvement. However, the statistical analysis could not be carried out since the sample size only contained 1 case. For patients without spontaneous resolution, it was 373.50±82.09 at the first visit and 387.50±130.93 at the last follow-up, indicating no statistical significance difference(t=0.492, P=0.664>0.05). 1.4 Macular edema: All patients with spontaneous resolution were relieved from cystoid macular edema to Diffuse macular edema(4 eyes, 100%). 2 The operation group: 2.1 Best corrected visual acuity: "V-type" patients were significantly improved compared with the preoperative conditions(F=58.009, P=0.000<0.05), so were "U-type"(F=30.352, P=0.000<0.05) and "J-type" patients(F=470.278, P=0.000<0.05). The difference among these three types was not statistically significant(F=1.343, P =0.279>0.05). 2.2 Central foveal thickness: The thickness was significantly reduced in "V-type" patients compared with the preoperative conditions(F=412.607, P=0.000<0.05), so were "U-type"(F=316.647, P=0.000<0.05) and "J-type" patients(F=972.929, P=0.000<0.05). The comparison among these three types showed that the thickness of "J-type" was significantly smaller than that of "V-type" and "U-type"(F=4.084, P=0.029<0.05). 2.3 Macular edema: All "V-type" patients were changed from cystoid macular edema to diffuse macular edema at one month after surgery(P<0.05). "U-type" patients were changed from cystoid macular edema to diffuse macular edema at 6 months after surgery(P<0.05). "J-type" patients were changed from cystoid macular edema to diffuse macular edema at three months after surgery(P<0.05). 2.4 b-wave amplitude: "V-type" patients were significantly improved compared with the preoperative conditions(F=323.552, P=0.000<0.05), so were "U-type"(F=546.967, P=0.000<0.05) and "J-type" patients(F=585.500, P=0.000<0.05). The comparison among these three types showed that the amplitude of "U-type" and "J-type" was significantly smaller than that of "V-type"(F=8.005, P=0.002<0.05).Conclusion:1 Firstly proposes the typing basis for vitreomacular traction syndrome.2 Different VTS types are associated with different prognosis. "V-type" patients should be observed within a definite time, and the appropriate period are 6 months. Surgery should be actively considered for "U-type" patients, while "J-type" patients should undergo surgery immediately.3 Treatment of vitreomacular traction syndrome with pars plana vitrectomy and internal limiting membrane peeling combined with intraocular pneumatic retinopexy can recover the stretched retinal structure and improve macular functions.4 Different vitreomacular traction syndrome types are associated with different surgical prognosis.5 Pars plana vitrectomy and internal limiting membrane peeling combined with intraocular pneumatic retinopexy prove to be a safe and effective surgical method in the treatment of vitreomacular traction syndrome. |
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