Predictive factors of spontaneous release of vitreomacular traction: a systematic review and meta-analysis

Purpose: To review predictive factors of spontaneous vitreomacular traction (VMT) release.

Methods: A systematic literature search was performed on Ovid MEDLINE, Embase, and Cochrane Library. Studies comparing spontaneously released VMT to persistent VMT were included. A meta-analysis was performed using a random effects model, and weighted mean difference (WMD), risk ratio (RR) and 95% confidence intervals (95%CI) were reported as appropriate.

Results: Out of a search of 258 studies, twelve studies were included, from which 272 out of 934 eyes (29%) underwent spontaneous release. Mean age was 70.0 years, 37.2% of patients were male, and mean follow-up was 22.0 months. Significant predictive factors for spontaneous release were smaller VMT diameter (n=177; WMD=-212.48μm, 95%CI=[-417.36, -7.60], P=0.04), epiretinal membrane (ERM) absence (n=162; RR=2.17, 95%CI=[1.18,3.97], P=0.01), and right eye involvement (n=76; RR=2.10, 95%CI=[1.14,3.88], P=0.02). Non-significant factors were age, initial best corrected visual acuity (BCVA), sex, ocular comorbidity, fellow-eye posterior vitreous detachment, previous intravitreal injection, and VMT classification with focal defined as ≤400μm. Mean release time was 15.3 months (n=212). Mean BCVA improved from 0.34±0.21 (Snellen 20/44) to 0.20±0.58 logMAR (Snellen 20/32) post-release (n=121).

Conclusion: Smaller VMT diameter, ERM absence, and right eye involvement may support spontaneous VMT release. If patients have tolerable symptoms, clinicians may consider observation in patients with these predictive factors.

Garg A, Popovic MM, Cioana M, et al.  Predictive factors of spontaneous release of vitreomacular traction: a systematic review and meta-analysis. Retina. 2022



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