OBJECTIVE: To investigate the potential of an Optical Coherence Tomography (OCT) based Deep-Learning (DL) model in the prediction of Vitreomacular Traction (VMT) syndrome outcomes.
METHODS: A single-centre retrospective review.
METHODS: Records of consecutive adult patients attending the Royal Adelaide Hospital vitreoretinal clinic with evidence of spontaneous VMT were reviewed from January 2019 until May 2022. All patients with evidence of causes of cystoid macular oedema or secondary causes of VMT were excluded. OCT scans and outcome data obtained from patient records was used to train, test and then validate the models.
RESULTS: For the deep learning model, ninety-five patient files were identified from the OCT (SPECTRALIS system; Heidelberg Engineering, Heidelberg, Germany) records. 25% of the patients spontaneously improved, 48% remained stable and 27% had progression of their disease, approximately. The final longitudinal model was able to predict \'improved\' or \'stable\' disease with a positive predictive value of 0.72 and 0.79, respectively. The accuracy of the model was greater than 50%.
CONCLUSIONS: Deep-learning models may be utilised in real-world settings to predict outcomes of VMT. This approach requires further investigation as it may improve patient outcomes by aiding ophthalmologists in cross-checking management decisions and reduce the need for unnecessary interventions or delays.

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.

To describe a case of transient bilateral vitreomacular traction syndrome associated with topical 1% pilocarpine ophthalmic solution in both eyes as a treatment for advanced glaucoma.
UNASSIGNED: Spectral-domain OCT demonstrated bilateral vitreomacular traction syndrome after initiation of topical 1% pilocarpine solution in both eyes for advanced glaucoma. Follow-up imaging revealed the resolution of vitreomacular traction after cessation of the drug without a complete posterior vitreous detachment.
UNASSIGNED: In the advent of new pilocarpine formulations, this case raises the concern of vitreomacular traction syndrome as a serious potential sequela of long-term topical pilocarpine use.

Vitreomacular Interface pathology and its surgical treatment is an ever-evolving field in vitreoretinal surgery. Various treatments have been proposed for macular holes associated with vitreomacular traction including ocriplasmin injection, gas injection, and pars plana vitrectomy with posterior hyaloid face stripping with or without internal limiting membrane peeling. The time of intervention in patients with vitreomacular traction syndrome is also a point of contention among researchers. Here we present a case of an 83-year-old male patient who presented to the outpatient department with a history of grossly decreased visual acuity of counting fingers in the right eye. An altered foveal reflex was seen in an otherwise unremarkable ocular examination. The left eye revealed no pertinent findings. The patient was diagnosed with vitreomacular traction syndrome on spectral domain optical coherence tomography. There was an associated grade 1b macular hole according to the International Vitreomacular Traction Study classification. As the roof of the macular hole was intact, we decided to proceed with pars plana vitrectomy and careful stripping of the posterior hyaloid face. However, this resulted in a full-thickness macular hole and no change in visual acuity. A second surgery comprising internal limiting membrane peel using brilliant blue dye with perfluoropropane (C3F8) gas tamponade was done. Follow-up after six weeks showed a visual acuity improvement to 20/120 and restoration of foveal configuration. To the best of our knowledge, such a clinical case has not been reported in locally published literature.

OBJECTIVE: To evaluate whether the systemic oxidative stress biomarkers increased in patients with vitreomacular traction syndrome (VMT).
METHODS: This study compared 25 patients diagnosed with VMT with 20 healthy controls. As a biomarker of systemic oxidative stress, malondialdehyde (MDA) was measured. Total oxidant status (TOS) and total antioxidant status (TAS) were measured to evaluate the systemic oxidant status.
RESULTS: Serum MDA values were significantly higher among the patients (p < 0.001). The ideal cut-off value for MDA was determined to be 22.1 µmol/L, with 80% sensitivity and 75% specificity. The between-group differences were not statistically significant for TOS or TAS (p = 0.326 and p = 0.698, respectively).
CONCLUSIONS: Increased MDA levels suggest that systemic oxidative stress may play a role in VMT.

OBJECTIVE: To retrospectively review and analyze the clinical and imaging data of patients with vitreomacular traction syndrome (VMTS) with strong peripheral vitreoretinal adhesion.
METHODS: This retrospective case-series study involved 4 eyes of 4 VMTS patients with vitreoretinal adhesion in both the macular region and the periphery who underwent vitreous surgery. In all 4 cases, preoperative refraction, fundoscopic findings, optical coherence tomography (OCT) findings, and intraoperative findings were evaluated.
RESULTS: The preoperative fundoscopy and OCT findings revealed fibrous membranes around the optic nerve head in 3 eyes. Thickened posterior vitreous membranes extending from the posterior pole to the periphery were observed in all eyes. Apparent VMTS or epimacular membrane was also found in the fellow eyes of 2 patients. The preoperative refractive errors ranged from +0.5 diopters (D) to +2.75 D (mean, +1.13 D). Intraoperatively, a thickened posterior vitreous membrane was found strongly adhered to the retina in the macula regions, optic nerve head, and periphery. In 2 eyes, when artificial posterior vitreous detachment (PVD) was created, an iatrogenic tear developed in the periphery.
CONCLUSIONS: The features of VMTS that cause strong peripheral vitreoretinal adhesion include the preoperative presence of a thickened posterior vitreous membrane over a wide area, hypermetropia, and a short axial length.

OBJECTIVE: To describe and analyze short-term posterior vitreous abnormalities following intravitreal ocriplasmin in eyes with symptomatic vitreomacular traction syndrome (VMT).
METHODS: In this institutional, prospective and interventional study enrolled patients with symptomatic focal VMT syndrome treated with intravitreal ocriplasmin. In all cases, spectral-domain optical coherence tomography scans were quantitatively and qualitatively analyzed preoperatively and at 1 and 4 weeks postoperatively.
RESULTS: Twenty-three patients, of which 5 were males and 18 females, with a mean age of 69.5 ± 8.2 years were included in this study. Postoperatively, VMT resolved in 11 of 23 eyes (47.8%). In 9 out of 11 cases (81.8%), VMT resolved by postoperative week 1, whether in the remaining 2 (18.2%) anatomical restoration, was diagnosed at postoperative week 4. At postoperative week 1, a foveolar detachment was detected in 9 out of 23 eyes (39.1%). The foveolar detachment resolved all but one eye by the end of postoperative week 4. At the end of the follow-up period, the presence of subretinal fluid was detected in 7 out of 9 eyes (77.8%), and it was significantly associated with a shrinkage of the posterior vitreous cortex (p < 0.006). At the end of the follow-up period, visual acuity was significantly higher in those eyes with VMT resolution (p < 0.001).
CONCLUSIONS: Intravitreal ocriplasmin is effective for the treatment of patients with VMT. The postoperative presence of posterior hyaloid shrinkage may be associated with higher traction over the foveal area and the appearance of foveolar detachment.

OBJECTIVE: To develop a new classification system for vitreomacular traction (VMT) syndrome according to spectral-domain optical coherence tomography (SD-OCT) imaging and to investigate the clinical course of VMT patients.
METHODS: This study included 68 eyes of 68 consecutive patients who were followed with observation or treated with vitrectomy for idiopathic VMT. Eyes were classified into one of three groups according to SD-OCT findings: group A (foveal pseudocyst, which was defined as the formation of cystoid cavity located in the inner part of the central fovea along with foveal thickening), group B (parafoveal retinoschisis, which was defined as intraretinal cysts or clefts along with no apparent foveal thickening), and group C (outer retinal dehiscence at the fovea, which is sometimes accompanied by foveal thinning). The minimum required follow-up period was 1 year. Clinical course and anatomical and functional outcomes were compared among the groups.
RESULTS: Twenty-seven eyes (39.7%) were included in group A, 22 eyes (32.4%) were included in group B, and 19 eyes (27.9%) were included in group C. Among the 24 eyes that were managed by observation, a significantly larger percentage of patients in group A (6/10 [60%]) exhibited more spontaneous resolution of VMT compared with those in groups B (9.1%) or C (0%) (P = 0.010). In the 44 eyes that were managed with vitrectomy, a significantly larger percentage of patients in group C (4/16 [25%]) experienced subsequent full-thickness macular hole development following vitrectomy compared with those in groups B (0%) or C (0%) (P = 0.014). The percentage of patients with photoreceptor inner segment/outer segment disruption was significantly reduced in group A after vitrectomy, with group C exhibiting the lowest recovery rate. Postoperatively, group A experienced a significantly better visual outcome than group C (P = 0.021).
CONCLUSIONS: A novel configuration system offering insight into the clinical course of VMT is proposed. According to this system, anatomical and functional outcomes were favorable in group A and worse in group C.

This study was conducted to reveal the role of systemic low-grade inflammation by calculating the Neutrophil/Lymphocyte Ratio (NLR) in Vitreomacular Traction Syndrome (VMTS) of different etiologies. A retrospective examination was made of the medical records at a tertiary referral hospital. The study included 31 patients with diabetic VMTS, 27 patients with idiopathic VMTS, and 35 healthy subjects as the control group. The White Blood Cell (WBC) counts and Neutrophil-to-Lymphocyte Ratio (NLR) was compared. There were insignificant differences between the groups in terms of mean age and female/male ratio (P>0.05). The mean ± Standard Deviation (SD) of NLR was calculated as 2.43 ± 0.83 in the diabetic VMTS group, 2.38 0.96 in the idiopathic VMTS group, and 1.83 WBC: White blood cell; VMTS: Vitreomacular traction syndrome; SD: standard deviation; µL: microliter; fL: femtolitre; n: number. 0.52 in the control group (P=0.007). The values of the diabetic and idiopathic VMTS groups were significantly higher than those of the control group (P=0.002 and P=0.032, respectively). However, differences between the diabetic and idiopathic VMTS groups were insignificant (P=0.651). This study found significantly higher NLR in patients with diabetic and idiopathic VMTS than the control group. Elevated NLR could therefore be a potential indicator of VMTS, irrespective of the etiology.

OBJECTIVE: To evaluate the changes in anterior chamber flare after a single intravitreal injection of ocriplasmin (125 μg), in patients with symptomatic vitreomacular traction syndrome (VMT).
METHODS: An institutional review board-approved single-center not randomized prospective study.
METHODS: Fifteen eyes of fifteen patients (9 women, 6 men) underwent intravitreal injection with ocriplasmin for symptomatic VMT (width of attachment ≤ 1500 μm). Anterior segment flare was measured with a laser flare meter (Kowa) before intravitreal injection and 1 day, 1 week, 1 month after injection. The changes in flare were analyzed; the resolution of VMT was evaluated with spectral-domain OCT.
RESULTS: The mean anterior chamber flare was 10.5 ± 1.9 photons per millisecond (photons/ms) before the injection. After 1 day it increased to 13.6 ± 2.7 photons/ms (p = 0.027) and after 1 week to 14.4 ± 2.5 photons/ms (p = 0.005); after 1 month it decreased to 12.3 ± 2.3 photons/ms (p = 0.123). At 1 day and 1 week after injection, mean anterior chamber flare of fellow eyes was significantly lower than study eyes, while at 1 month this difference was not significant (12.3 ± 2.3 vs. 10.5 ± 1.8 photons/ms, p = 0.124, for study and fellow eyes). There was no statistically significant difference in the changes in flare between women and men or between phakic (N = 10) and pseudophakic (N = 5) eyes. No eye demonstrated intraretinal damage at any time-point. Also, 9 eyes showed resolution of VMT while 6 eyes demonstrated persistence of VMT.
CONCLUSIONS: Our study shows that intravitreal injection of ocriplasmin can be a safe and effective approach to treat symptomatic VMT syndrome in selected patients.