Optical coherence tomography (OCT) is an imaging technology that can clearly define the vitreoretinal interface. The preoperative and postoperative features of vitreomacular traction (VMT) have been described in a recent case report.1 In the present case, serial OCT images documented the natural history of VMT secondary to intermediate uveitis. This is the first report demonstrating spontaneous resolution of VMT with OCT.
The patient is a 60-year-old white woman with a 1½-year history of stable, bilateral intermediate uveitis treated with prednisolone acetate drops twice daily in both eyes. Five months before her initial visit to us, her visual acuity dropped to 20/60 OS from 20/25 OS. Six weeks before referral to us, visual acuity dropped further to 20/80 OS and a sub-Tenon triamcinolone acetonide injection was administered in the left eye. The patient was referred to our retina service for evaluation of continuing decreased vision in her left eye.
Best-corrected Snellen visual acuity was 20/30 OD and 20/70 OS. Applanation tonometry revealed intraocular pressures of 19 mm Hg in the right eye and 27 mm Hg in the left, likely secondary to the corticosteroid injection. Slitlamp examination revealed trace pigmented cells in the anterior chambers of both eyes. Dilated fundus examination revealed a normal retina in the right eye and multiple foveal cysts in the left eye. Fluoroscein angiography did not reveal cystoid macular edema. The OCT image of the left eye revealed a partially detached posterior hyaloid exerting traction on the fovea and secondary intraretinal thickening with large cystic spaces (Figure 1, A). Treatment was observation at this time with pars plana vitrectomy to be considered to relieve the traction if visual loss persisted in the setting of quiescent uveitis.
A, On the patient's initial visit, the optical coherence tomographic image demonstrates a partially detached posterior hyaloid located 750 µm anterior to the retina, which is characteristic of vitreomacular traction. There are cystic intraretinal spaces produced by vitreous traction in the fovea. The foveal contour is irregular. B, One month later the posterior hyaloid is more elevated and located 1020 µm anterior to the retina but the area of vitreoretinal attachment is decreased. Central foveal thickness is decreased and measures 180 µm. C, Four months after the initial visit, there is complete release of posterior hyaloid attachment to the retina with residual intraretinal edema nasal to the fovea. Central foveal thickness is 210 µm.
One month later the patient reported spontaneous improvement in vision. Best-corrected visual acuity improved to 20/40 OS. Retinal examination revealed persistent vitreous traction at the fovea although retinal thickening appeared to be decreased. The OCT image of the left eye revealed that the posterior hyaloid had largely detached from the retina although a focal area of adhesion remained temporal to the fovea (Figure 1, B).
Four months after the initial visit the patient reported no visual complaints and visual acuity improved to 20/30 OS. Retinal examination revealed resolution of the central retinal thickening and a taut posterior hyaloid anterior to the fovea. The OCT image confirmed complete detachment of the posterior hyaloid, diminished retinal thickening, and restoration of the normal foveal contour (Figure 1, C).
Vitreomacular traction is a result of detachment of the posterior vitreous with persistent vitreomacular adhesions that produce retinal thickening and cystic changes.2 In this case the cause appears to have been intermediate uveitis because the pattern of adhesion and the patient's course after vitreomacular separation are consistent with previous descriptions by Schepens et al.3
Optical coherence tomography is a diagnostic technique that may be useful in distinguishing the morphologic characteristics of a wide variety of retinal abnormalities.4 This case illustrates the utility of OCT in diagnosis and follow-up of patients with VMT. Over a 4-month period, our patient's condition spontaneously improved, both subjectively and on the OCT images, and this is attributed to detachment of the posterior hyaloid from the macular surface. As spontaneous resolution may occur in some eyes with VMT, a period of observation with sequential OCT evaluations to assess the vitreous anatomy may be considered prior to surgical intervention.
Corresponding author: Caroline R. Baumal, MD, New England Eye Center, 750 Washington St, Box 450, Boston, MA 02111.
Sulkes DJ, Ip MS, Baumal CR, Wu HK, Puliafito CA. Spontaneous Resolution of Vitreomacular Traction Documented by Optical Coherence Tomography. Arch Ophthalmol. 2000;118(2):286-287. doi: