Predictive factors associated with the visual prognosis after surgery for idiopathic vitreomacular traction

Purpose: To investigate the predictive factors for postsurgical visual prognosis in patients with vitreomacular traction (VMT).

Methods: This retrospective study enrolled 31 eyes from 29 patients who underwent vitrectomy for idiopathic VMT with a follow-up period of ≥ 3 months. The VMT was divided into three grades based on optical coherence tomography images: Grade 1 denoted partial vitreomacular separation with foveal attachment; Grade 2 exhibited intraretinal cysts or cleft with grade 1 findings; and Grade 3 was Grade 2 plus the subretinal fluid.

Results: Three eyes developed a full-thickness macular hole after surgery, all of which were Grade 3 patients. In the rest 28 eyes, the mean postoperative follow-up period was 23.3 ± 25.8 months. The postoperative central foveal thickness (P = 0.001) and final best- corrected visual acuity (BCVA; P < 0.001) were both significantly improved from baseline. Fifteen eyes (53.8%) gained ≥ two Snellen lines. Multilinear regression analysis showed that the worse the baseline BCVA (P = 0.004), or the more advanced the VMT grade (P = 0.049), the worse the final BCVA. Baseline BCVA was negatively associated with the post- operative visual improvement (P < 0.001). Those Grade 3 patients with baseline Snellen BCVA of ≥ 20/40 were more likely to achieve a final Snellen BCVA of ≥ 20/25 (P = 0.035).

Conclusion: The VMT grade is an important predictive factor for the postsurgical visual prognosis. Surgical intervention should be performed as early as possible for Grade 3 patients to prevent further disease progression and maximize the postsurgical visual benefit.