The purpose of this study was to investigate the clinical course of patients with idiopathic vitreomacular adhesion (VMA) with a noncomparative case series of patients who had clinical symptoms and spectral-domain optical coherence tomography findings consistent with VMA. The VMA was graded based on the optical coherence tomography findings at initial and follow-up examinations. Grade 1 was incomplete cortical vitreous separation with attachment at the fovea, Grade 2 was the Grade 1 findings and any intraretinal cysts or clefts, and Grade 3 was the Grade 2 findings and the presence of subretinal fluid. Results: 106 eyes of 81 patients were identified as having VMA by spectral-domain optical coherence tomography with mean age at 73 years and the mean time of follow-up was 23 months. Forty-three eyes (41%) had Grade 1 VMA, 56 eyes (52%) had Grade 2 VMA, and seven eyes (7%) had Grade 3 VMA. By the last follow-up, spontaneous release of VMA occurred in 34 eyes (32%), and pars plana vitrectomy was performed in five eyes (4.7%). Mean best corrected visual acuity was 0.269 logarithm of the minimum angle of resolution or 20/37 at baseline (range, 20/20–20/200) and logarithm of the minimum angle of resolution 0.251 or 20/35 at the last examination (range, 20/20–20/400). The study concluded that in this selected patient cohort with mild symptoms, the clinical course of patients with VMA managed by initial observation was generally favourable.

Clinical course of vitreomacular adhesion managed by initial observation.
Vishak J, Flynn H, Smidy W, et al.
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Nikolaos D Georgakarakos

Moorfields Eye Hospital, London, UK.

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