BACKGROUND: We conducted a systematic review to compare  the effects of pneumatic vitreolysis (PV), enzymatic vitreolysis (EVL) with ocriplasmin, and pars plana vitrectomy (PPV) on vitreomacular traction (VMT) syndrome and macular holes (MHs) to assess their efficacy as treatment options.
METHODS: Databases, including PubMed, ClinicalTrials.gov ( www.
RESULTS: gov ), the Cochrane Central Register of Controlled Trials (CENTRAL)-including the Cochrane Eyes and Vision Group Trials Register (The Cochrane Library 2013, Issue 2)-, Ovid MEDLINE, and EMBASE (January 2000-October 2022), were searched to identify studies comparing the outcomes of PV versus PPV, PPV versus ocriplasmin and ocriplasmin versus PV. RevMan 5.1 was used for the meta-analysis of the studies.
RESULTS: Among the 89 studies, 79 were considered eligible for qualitative analysis, and 10 quantitative studies were subjected to meta-analysis. PPV resulted in better postoperative visual acuity improvement than ocriplasmin (standardized mean deviation (SMD) = 0.38, 95% CI 0.03-0.73, p = 0.0003). PV resulted in no significant difference in visual improvement compared  with  PPV (SMD = - 0.15, 95% CI - 0.47 to 0.16, p = 0.35). PPV was significantly more effective in terms of the VMT release rate (risk ratio = 0.48, 95% CI 0.38-0.62, p = 0.00001) and MH closure rate (risk ratio = 0.49, 95% CI 0.30-0.81, p = 0.006) than ocriplasmin. PV was more effective than ocriplasmin in terms of the VMT release rate (risk ratio = 0.49, 95% CI 0.35-0.70, p = 0.0001). Qualitative analysis showed MH closure rates of 46%, 47.8%, and 95% and VMT releases rates of 46%, 68% and 100% after ocriplasmin, PV, and PPV treatments, respectively.  Adverse events and postoperative complications occurring after treatment have also been documented in these studies.
CONCLUSIONS: PPV appears to be the most promising option for MH closure and VMT release, with fewer serious complications than EVL  or PV. However, given the limited number of studies comparing these treatments, further research is needed to establish the superiority of PPV over the other options.

UNASSIGNED: To report a case of release of vitreomacular traction (VMT) in a patient with a full thickness macular hole (FTMH) immediately following pneumatic vitreolysis (PV) combined with head bobbing movements.
UNASSIGNED: A 71-year-old female with VMT and an FTMH presented with blurred vision for 2 months to the level of 20/400. At her 1-month follow-up visit, PV was performed using C3F8 gas and she was instructed to perform the drinking bird technique for ten minutes.
UNASSIGNED: Optical coherence tomography performed ten minutes after PV with head bobbing showed VMT release and a smaller FTMH. Visual acuity improved to 20/150 immediately afterwards and to 20/80 two months later.
UNASSIGNED: Using the drinking bird technique for a continuous period of time immediately following PV may encourage rapid VMT release. PV may be a feasible option for patients with VMT and FTMH who do not want surgery.

UNASSIGNED: To determine whether pneumatic vitreolysis with intravitreal air is effective for focal vitreomacular traction (VMT).
UNASSIGNED: We conducted a retrospective consecutive case series of 20 eyes from 19 individuals with focal VMT who underwent pneumatic vitreolysis with intravitreal air (January 2017 to November 2018). We analyzed patients via spectral-domain optical coherence tomography before intravitreal air injection and at 1 month. The primary outcome measure was release of VMT.
UNASSIGNED: We observed release of VMT in 55% of individuals. An analysis limited to phakic eyes demonstrated release of VMT in 69%, and 65% developed improved best-corrected visual acuity. Individuals with persistent VMT and visual improvement had a significant reduction in angle of vitreoretinal insertion (P < .01), area under VMT (P < .05), and subfoveal cyst area (P < .05).
UNASSIGNED: Intravitreal air is an effective treatment for focal VMT. In individuals with persistent VMT, visual-acuity improvement was associated with a reduction in overall VMT.

OBJECTIVE: To evaluate the efficacy of single intravitreal injection of an expansile concentration of sulphur hexafluoride gas (SF6) in treating patients with symptomatic focal vitreomacular traction (VMT) documented by spectral domain optical coherence tomography (SD-OCT) preoperatively.
METHODS: This is a prospective interventional case series including 30 eyes of 29 patients with symptomatic focal VMT evident on SD-OCT. Pre-operatively, mean best corrected visual acuity (BCVA) was 20/125 (range 20/400-20/40). Mean central foveal thickness (CFT) was 382 μm (range 149-576 μm; SD ± 91.88). All eyes received single intravitreal injection of 0.3 mL of 100% SF6 gas. Postoperatively, we performed SD-OCT at one week, one month, and three months for all eyes. Primary outcome measure was release of VMT. Secondary outcome measures were changes in postoperative BCVA andCFT.
RESULTS: Overall, VMT release occurred in 24 of 30 eyes by the final follow-up visit (80% final release rate); furthermore, 76.9% of eyes with diabetic maculopathy and 25% of eyes with concurrent epiretinal membrane (ERM) had successful VMT release. VMT release was documented on SD-OCT at an average of 3 weeks (range, 1-12 weeks). The rate of release in phakic eyes was 90% (18 of 20 eyes) versus 60% in pseudophakic eyes (6 of 10 eyes). One patient developed a retinal break at upper nasal retina after two weeks of injection.
CONCLUSIONS: Pneumatic vitreolysis (PVL) with limited face-down position is a viable option for treating focal VMT with few adverse events. Further studies are needed to evaluate its indications, benefits, and risks.

OBJECTIVE: To evaluate the outcome of pneumatic vitreolysis (PVL) for vitreomacular traction (VMT) with or without full thickness macular hole (MH) < 400 µm.
METHODS: Forty-seven eyes of 47 patients were included who had undergone PVL for VMT with or without MH. Main outcome measures were release of VMT, MH closure, best-corrected visual acuity (BCVA) and adverse events.
RESULTS: Thirty-three patients had isolated VMT and 14 patients VMT with a MH. Four weeks after PVL, the overall VMT release rate was 35/47 (74.5%): 25/37 (67.6%) in phakic and 10/10 (100%) in pseudophakic eyes (p = 0.03). Four of 14 MH (28.6%) were closed. Twenty-two of 47 (46.8%) eyes required a subsequent PPV: 12/33 (36.4%) in the VMT only group and 10/14 (71.4%) in the VMT with MH group. Mean BCVA improved from 0.48 (± 0.24) to 0.34 (± 0.23) logMAR at 6 months in patients with VMT alone (p < 0.001), and from 0.57 (± 0.27) to 0.41 (± 0.28) logMAR in patients with VMT and MH (p = 0.008). Adverse events included new formation of a large MH in 4/33 (12.1%) eyes, failure of MH closure in 10/14 (71.4%) eyes, progression of mean minimum linear diameter (MLD) MH size from baseline 139 (± 67) to 396 (± 130) µm (p < 0.001) and development of a retinal detachment in 4/47 (8.5%) eyes.
CONCLUSIONS: While PVL leads to a high VMT release rate particularly in pseudophakic eyes, it is associated with a relatively high incidence of MH formation, MH size progression and retinal detachment.

To evaluate pneumatic vitreolysis (PVL) in eyes with vitreomacular traction (VMT) with and without full-thickness macular hole (FTMH).
Two multicenter (28 sites) studies: a randomized clinical trial comparing PVL with observation (sham injection) for VMT without FTMH (Protocol AG) and a single-arm study assessing PVL for FTMH (Protocol AH).
Participants were adults with central VMT (vitreomacular adhesion was ≤3000 μm). In Protocol AG, visual acuity (VA) was 20/32 to 20/400. In Protocol AH, eyes had a FTMH (≤250 μm at the narrowest point) and VA of 20/25 to 20/400.
Pneumatic vitreolysis using perfluoropropane (C3F8) gas.
Central VMT release at 24 weeks (Protocol AG) and FTMH closure at 8 weeks (Protocol AH).
From October 2018 through February 2020, 46 participants were enrolled in Protocol AG, and 35 were enrolled in Protocol AH. Higher than expected rates of retinal detachment and tear resulted in early termination of both protocols. Combining studies, 7 of 59 eyes (12% [95% CI, 6%-23%]; 2 eyes in Protocol AG, 5 eyes in Protocol AH) that received PVL developed rhegmatogenous retinal detachment (n = 6) or retinal tear (n = 1). At 24 weeks in Protocol AG, 18 of 23 eyes in the PVL group (78%) versus 2 of 22 eyes in the sham group (9%) achieved central VMT release without rescue vitrectomy (adjusted risk difference, 66% [95% CI, 44%-88%]; P< 0.001). The mean change in VA from baseline at 24 weeks was 6.7 letters in the PVL group and 6.1 letters in the sham group (adjusted difference, -0.8 [95% CI, -6.1 to 4.5]; P = 0.77). In Protocol AH, 10 of 35 eyes (29% [95% CI, 16%-45%]) achieved FTMH closure without rescue vitrectomy at 8 weeks. The mean change in VA from baseline at 8 weeks was -1.5 letters (95% CI, -10.3 to 7.3 letters).
In most eyes with VMT, PVL induced hyaloid release. In eyes with FTMH, PVL resulted in hole closure in approximately one third of eyes. These studies were terminated early because of safety concerns related to retinal detachments and retinal tears.

To evaluate the posterior vitreous release rates after a single injection of expansile gas in patients with vitreomacular traction (VMT) syndrome with or without associated full-thickness macular hole (FTMH).
Thirteen eyes of 12 consecutive patients with VMT (11 eyes) or VMT+FTMH (2 eyes) were reviewed retrospectively. Intravitreal injection of 0.3 mL of pure sulfur hexafluoride (SF6) (9 eyes) or perfluoropropane (C3F8) (4 eyes) was performed. Bobbing the head forward and backward similar to ‘drinking bird’ head movements was instructed until VMT release. Full ophthalmic examination and optical coherence tomography was performed at each visit.
VMT was released in all patients (100%) and mean release time was 5.2 days (1-19 days). Macular hole closure was not achieved in either of the two eyes with FTMH. Mean central subfield thickness decreased significantly from 361 μm to 263 μm (p=0.007). The mean pretreatment visual acuity was 0.44 LogMAR, which significantly improved to 0.25 LogMAR at the last visit (p=0.003). One of 13 eyes had retinal tear after the procedure which was successfully treated with laser retinopexy. Gas migration to the anterior chamber occurred in one patient. No other complications were observed.
Pneumatic vitreolysis with C3F8 and SF6 gases is a relatively safe, low-cost, and minimally invasive treatment modality for VMT. However, FTMH closure could not be achieved with pneumatic vitreolysis.

UNASSIGNED: To present, to the authors\' knowledge, the first reported case of loculated subretinal fluid associated with pneumatic vitreolysis (PVL).
UNASSIGNED: A 74 year old female was followed for 9 months with vitreomacular traction (VMT) and 20/20 visual acuity in her right eye. Her visual acuity decreased at 9 months to 20/50 and she was treated with PVL. VMT release was successful on day 7. An isolated shallow pocket of loculated subretinal fluid developed inferotemporal to the fovea at one month after PVL and persisted for 14 months. The subretinal fluid eventually resolved at 14 months after PVL, and visual acuity improved to 20/30, and there were no electroretinographic abnormalities.
UNASSIGNED: Localized subretinal fluid is an unusual complication of PVL. No adverse visual outcome developed despite the persistent extrafoveal subretinal fluid in this case, and the subretinal fluid eventually resolved over a year after PVL.

BACKGROUND: We aimed to assess the efficacy of a single intravitreal perfluoropropane (C3F8) gas injection for the treatment of vitreomacular traction with or without a macular hole.
METHODS: In this retrospective case series, seven eyes of six patients with symptomatic vitreomacular traction documented on optical coherence tomography, one with a macular hole additionally, received a single intravitreal C3F8 gas injection of up to 0.3 ml. The primary endpoint was vitreomacular traction release at 1 month after injection. Secondary endpoints included resolution of vitreomacular adhesion within 6 months, nonsurgical closure of macular holes, and change in central foveal thickness and best-corrected visual acuity.
RESULTS: Overall, on optical coherence tomography, six of seven eyes (85.7%) had release of vitreomacular traction during the entire study duration: three within 1 month of injection and the other three within 6 months. Of the latter group, two of the three eyes showed a concurrent epiretinal membrane and one concurrent diabetic retino- and maculopathy. The patient with a macular hole had resolution of vitreomacular traction within 1 month but had to undergo vitrectomy because of nonclosure of the macular hole. Associated adverse events were macular edema with a consequent lamellar hole after injection in one patient, and another patient developed retinal detachment.
CONCLUSIONS: Intravitreal C3F8gas injection is an inexpensive and promising minimally invasive option for the treatment of symptomatic and persistent vitreomacular traction with or without a macular hole. Further larger studies, especially comparing C3F8 gas injection with other treatment options, are needed.
UNASSIGNED: Ziel der vorliegenden Fallserie war es, die Wirksamkeit einer einmaligen intravitrealen Applikation von Perfluoropropangas (C3F8) für die Behandlung der vitreomakulären Traktion mit oder ohne Makulaloch zu beurteilen.
METHODS: In dieser retrospektiven Fallserie bekamen 7 Augen von 6 Patienten mit einer symptomatischen vitreomakulären Traktion in der optischen Kohärenztomographie, eine davon mit zusätzlich einem Makulaloch, eine einmalige intravitreale C3F8-Gasinjektion von bis zu 0,3 ml. Der primäre Endpunkt war die Lösung der vitreomakulären Traktion einen Monat nach der Injektion. Die sekundären Endpunkte beinhalteten die Lösung der vitreomakulären Traktion innerhalb von 6 Monaten, die Verschließung eines Makulalochs ohne weitere vitreoretinale Intervention, Veränderungen in der zentralen fovealen Dicke und der Sehschärfe.
UNASSIGNED: Insgesamt bestand bei 6 von 7 Augen (85,7 %) eine mit optischer Kohärenztomographie dokumentierte Lösung der vitreomakulären Traktion; 3 innerhalb eines Monats und 3 weitere innerhalb eines halben Jahres. Von den Letzteren wiesen 2 der 3 Augen gleichzeitig eine epiretinale Membran auf und eines eine simultane diabetische Retino- und Makulopathie. Der Patient mit einem Makulaloch zeigte innerhalb eines Monats eine vitreomakuläre Traktionslösung, musste sich jedoch wegen Persistenz des Makulalochs einer Vitrektromie unterziehen. Assoziierte unerwünschte Ereignisse waren ein Makulaödem mit einem Schichtloch nach der Injektion bei einem Patienten und eine Netzhautablösung bei einem anderen Patienten.
UNASSIGNED: Die intravitreale Gasinjektion mit C3F8-Gas ist eine kostengünstige und vielversprechende minimalinvasive Option für die Behandlung von symptomatischer vitreomakulärer Traktion mit oder ohne Makulaloch. Weitere größere Studien, in der v. a. die C3F8-Gasinjektion mit anderen Therapieoptionen verglichen wird, sind erforderlich.

Pneumatic vitreolysis (PVL) is the intravitreal injection of a small quantity of expansile gas for the purpose of achieving focal vitreomacular traction (VMT) release for eyes with symptomatic VMT, or inducing VMT release and closure of the macular defect for eyes with a small stage-2 macular hole (MH). Initially, there was limited interest in this technique upon its introduction for clinical treatment in human eyes in 1993. With the advent of optical coherence tomography allowing detailed observation of vitreomacular interface changes and rising importance of medical economics in recent years, there has been increasing interest in PVL, a low-cost procedure for managing symptomatic VMT. The success rates of VMT release in the literature have ranged from 60% to 100% and the rates of closure of small macular holes have ranged from 50% to 80% following PVL. In a recent retrospective consecutive series of 56 eyes in two centers undergoing C3F8 gas injection, Chan and Mein reported an overall success of 86% in VMT release and 60% closure of small macular holes with few adverse events (7% with retinal breaks, retinal detachment, or progression of VMT). Multiple recent studies have shown superior outcome utilizing C3F8 gas compared with SF6 gas for PVL. In conclusion, PVL is a promising, low-cost therapeutic option, with the potential for managing symptomatic focal VMT on a global scale.