Abstract：
OBJECTIVE: To compare pneumatic vitreolysis and pars plana vitrectomy in the management of focal symptomatic vitreomacular traction (VMT).
METHODS: Patients aged 18 years or older, with idiopathic focal symptomatic VMT and best-corrected visual acuity <20/40, without any other retinal pathology were randomized to undergo pneumatic vitreolysis (Group 1) or pars plana vitrectomy (Group 2). The primary outcome measure was resolution of traction confirmed with optical coherence tomography at 3 months. Secondary outcome measures were to compare changes in best-corrected visual acuity, central foveal thickness, and complications if any.
RESULTS: A total of 30 eyes of 30 patients were included with 15 eyes in each group. Vitreomacular traction resolved successfully in 12 of 15 (80%) eyes in Group 1 and in all (100%) eyes in Group 2 (P = 0.224). The mean visual acuity improved from 0.80 ± 0.26 (20/126 Snellen\'s equivalent) to 0.70 ± 0.46 logMAR (20/100 Snellen\'s equivalent) in Group 1 (P = 0.71) and from 0.904 ± 0.44 (20/160 Snellen\'s equivalent) to 0.47 ± 0.26 logMAR (20/59 Snellen\'s equivalent) in Group 2 (P = 0.0016). Although 4 of 15 (26.66%) eyes in Group 1 had formation of full-thickness macular hole and 7 eyes required resurgery (4 for full-thickness macular hole and 3 for unresolved VMT), none in the pars plana vitrectomy group had any complications requiring resurgery (P = 0.0063). Two eyes in the pars plana vitrectomy group had intraoperative deroofing of the fovea leading to full-thickness macular hole.
CONCLUSIONS: Pars plana vitrectomy is better than pneumatic vitreolysis as a single intervention in the management of focal symptomatic VMT.
METHODS: Patients aged 18 years or older, with idiopathic focal symptomatic VMT and best-corrected visual acuity <20/40, without any other retinal pathology were randomized to undergo pneumatic vitreolysis (Group 1) or pars plana vitrectomy (Group 2). The primary outcome measure was resolution of traction confirmed with optical coherence tomography at 3 months. Secondary outcome measures were to compare changes in best-corrected visual acuity, central foveal thickness, and complications if any.
RESULTS: A total of 30 eyes of 30 patients were included with 15 eyes in each group. Vitreomacular traction resolved successfully in 12 of 15 (80%) eyes in Group 1 and in all (100%) eyes in Group 2 (P = 0.224). The mean visual acuity improved from 0.80 ± 0.26 (20/126 Snellen\'s equivalent) to 0.70 ± 0.46 logMAR (20/100 Snellen\'s equivalent) in Group 1 (P = 0.71) and from 0.904 ± 0.44 (20/160 Snellen\'s equivalent) to 0.47 ± 0.26 logMAR (20/59 Snellen\'s equivalent) in Group 2 (P = 0.0016). Although 4 of 15 (26.66%) eyes in Group 1 had formation of full-thickness macular hole and 7 eyes required resurgery (4 for full-thickness macular hole and 3 for unresolved VMT), none in the pars plana vitrectomy group had any complications requiring resurgery (P = 0.0063). Two eyes in the pars plana vitrectomy group had intraoperative deroofing of the fovea leading to full-thickness macular hole.
CONCLUSIONS: Pars plana vitrectomy is better than pneumatic vitreolysis as a single intervention in the management of focal symptomatic VMT.
摘要：
比较气压式玻璃体溶解术和平坦部玻璃体切除术在局灶性症状性玻璃体黄斑牵引（VMT）中的应用。
18岁或以上的患者，对于特发性局灶性有症状的VMT和最佳矫正视力<20/40,无任何其他视网膜病变的患者,我们随机接受充气玻璃体溶解术(第1组)或扁平部玻璃体切除术(第2组).主要结果测量是3个月时光学相干断层扫描证实的牵引分辨率。次要结果指标是比较最佳矫正视力的变化，中央凹厚度，和并发症，如果有的话。
共包括30例患者的30只眼，每组15只眼。第1组15只眼中的12只（80％）和第2组的所有（100％）眼中的玻璃体牵引成功解决（P=0.224）。第一组的平均视力从0.80±0.26（相当于20/126Snellen）提高到0.70±0.46logMAR（相当于20/100Snellen）（P=0.71），第二组的平均视力从0.904±0.44（相当于20/160Snellen）提高到0.47±0.26logMAR（相当于20/59Snellen）（P=0.0016）。尽管第1组的15只眼睛中有4只（26.66％）形成了全厚度黄斑裂孔，并且7只眼睛需要复活（全厚度黄斑裂孔4只，未解决的VMT3只），平坦部玻璃体切除术组无任何需要再次手术的并发症(P=0.0063).平坦部玻璃体切除术组的两只眼睛在术中对中央凹进行了脱毛，导致黄斑裂孔全层。
在局灶性症状性VMT的治疗中，平坦部玻璃体切除术优于充气玻璃体溶解术。
18岁或以上的患者，对于特发性局灶性有症状的VMT和最佳矫正视力<20/40,无任何其他视网膜病变的患者,我们随机接受充气玻璃体溶解术(第1组)或扁平部玻璃体切除术(第2组).主要结果测量是3个月时光学相干断层扫描证实的牵引分辨率。次要结果指标是比较最佳矫正视力的变化，中央凹厚度，和并发症，如果有的话。
共包括30例患者的30只眼，每组15只眼。第1组15只眼中的12只（80％）和第2组的所有（100％）眼中的玻璃体牵引成功解决（P=0.224）。第一组的平均视力从0.80±0.26（相当于20/126Snellen）提高到0.70±0.46logMAR（相当于20/100Snellen）（P=0.71），第二组的平均视力从0.904±0.44（相当于20/160Snellen）提高到0.47±0.26logMAR（相当于20/59Snellen）（P=0.0016）。尽管第1组的15只眼睛中有4只（26.66％）形成了全厚度黄斑裂孔，并且7只眼睛需要复活（全厚度黄斑裂孔4只，未解决的VMT3只），平坦部玻璃体切除术组无任何需要再次手术的并发症(P=0.0063).平坦部玻璃体切除术组的两只眼睛在术中对中央凹进行了脱毛，导致黄斑裂孔全层。
在局灶性症状性VMT的治疗中，平坦部玻璃体切除术优于充气玻璃体溶解术。
