Pneumatic Vitreolysis using C3F8 Gas in Treatment Naive Patients with Vitreomacular Traction

Czech version

Authors: Kateřina Marková; Pavel Němec; Petr Červený; Jan Havlik; Leoš Rejmont; Jan Tesař; Hana Morin; Martin Šín
Published in: Čes. a slov. Oftal., 80, 2024, No. Ahead of print, p. 1001-1008
Category: Original Article
doi: https://doi.org/10.31348/2024/34

Overview

Purpose: Evaluation of the effectiveness of pneumatic vitreolysis in disrupting vitreomacular traction in our own cohort of patients.

Methodology: Prospective follow-up of 21 eyes of 18 patients with focal VMT (adhesion width < 1500 µm) who underwent intravitreal injection of 0.3 ml of 100% perfluoropropane between January 2015 and December 2020. The patients were observed for 90 days.

Results: Release of VMT was achieved on the 28th day of observation in 15 out of 21 eyes (71.4%), and by the 90th day in 19 out of 21 eyes (90.5%). The average width of adhesion in our patients was 382 µm (±212 µm). Average best corrected visual acuity in our cohort was initially 0.77 (±0.21), after 28 days 0.74 (±0.30), and after 3 months 0.82 (±0.21). At the end of the follow-up period, we did not observe a statistically significant improvement in vision. Macular holes developed in two eyes, but spontaneously closed within 1 month of observation, and no more complications were observed in the cohort.

Conclusion: Pneumatic vitreolysis by intravitreal injection of C3F8 gas is an effective and inexpensive option for the management of symptomatic vitreomacular traction. The incidence of serious adverse events in our follow-up was significantly lower than in recently published series. The method of management should be selected individually according to the parameters of adhesion, macular hole and associated ocular pathologies.

Keywords:

Pars plana vitrectomy – intravitreal injection – C3F8 – vitreous detachment – perfluorocarbons – prospective study

Sources

Duker JS, Kaiser PK, Binder S, et al. The international vitreomacular traction study group classification of vitreomacular adhesion, traction, and macular hole. Ophthalmology 2013 December;120(12):2611- https://doi.org/10.1016/j.ophtha.2013.07.042
Rodrigues IA, Stangos AN, McHugh DA, Jackson TL. Intravitreal injection of expansile perfluoropropane (C3F 8) for the treatment of vitreomacular traction. Am J Ophthalmol 2013;155(2):270-276. https://doi.org/10.1016/j.ajo.2012.08.018
Chan CK, Mein CE, Crosson JN. Pneumatic vitreolysis for management of symptomatic focal vitreomacular traction. J Ophthalmic Vis Res 2017 October;12(4):419-423. https://doi.org/10.4103/jovr. jovr_146_17
Hikichi T, Yoshida A, Trempe CL. Course of vitreomacular traction syndrome. Am J Ophthalmol 1995 January;119(1):55-61. https:// doi.org/10.1016/s0002-9394(14)73813-9
John VJ, Flynn HW, Smiddy WE, et al. Clinical course of vitreomacular adhesion managed by initial observation. Retina 2014 March;34(3):442-446. https://doi.org/10.1097/ IAE.0b013e3182a15f8b
ChanCK,CrossonJN,MeinCE,DaherN.Pneumaticvitreolysisforrelief of vitreomacular traction. Retina 2017 October;37(10):1820-1831. https://doi.org/10.1097/IAE.0000000000001448
Day S, Martinez JA, Nixon PA, et al. Intravitreal sulfur hexafluoride injection for the treatment of vitreomacular traction syndrome. Retina 2016 April;36(4):733-737. https://doi.org/10.1097/ IAE.0000000000000760
Yu G, Duguay J, Marra K V, et al. Efficacy and safety of treatment options for vitreomacular traction: A Case Series and Meta-Analysis. Retina 2016 July;36(7):1260-1270. https://doi.org/10.1097/ IAE.0000000000000909
Claus MG, Feron E, Veckeneer M. Pneumatic release of focal vitreomacular traction. Eye (Basingstoke) 2017 March;31(3):411-416. https://doi.org/10.1038/eye.2016.231
Kaiser PK, Kampik A, Kuppermann BD, et al. Safety profile of ocriplasmin for the pharmacologic treatment of symptomatic vitreomacular adhesion/traction. Retina 2015 June;35(6):1111-1127. https://doi.org/10.1097/IAE.0000000000000448
Chan CK, Wessels IF, Friedrichsen EJ. Treatment of idiopathic macular holes by induced posterior vitreous detachment. Ophthalmology 1995 May;102(5):757-767. https://doi.org/10.1016/s01616420(95)30958-x
Costa RA, Cardillo JA, Morales PH, et al. Optical coherence tomography evaluation of idiopathic macular hole treatment by gas-assisted posterior vitreous detachment. Am J Ophthalmol 2001 August;132(2):264-266. https://doi.org/10.1016/S0002-9394(00)00903-X
Jorge R, Costa RA, Cardillo JA, et al. Optical Coherence Tomography Evaluation of Idiopathic Macular Hole Treatment by Gas-assisted Posterior Vitreous Detachment. Am J Ophthalmol 2006 November;142(5):869-871. https://doi.org/10.1016/j.ajo.2006.05.062
Mori K, Saito S, Gehlbach PL, Yoneya S. Treatment of Stage 2 Macular Hole by Intravitreous Injection of Expansile Gas and Induction of Posterior Vitreous Detachment. Ophthalmology 2007 January;114(1):127-133. https://doi.org/10.1016/j.ophtha.2006.07.001
Veith M. Treatment of Vitreomacular Traction with Intravitreal Injection of Perfluoropropane. Cesk Slov Oftalmol. 2020 January;75(4):182-187. https://doi.org/10.31348/2019/4/2
Quiroz-Reyes MA, Quiroz-Gonzalez EA, Quiroz-Gonzalez MA, Lima-Gomez V. Pneumatic vitreolysis versus vitrectomy for the treatment of vitreomacular traction syndrome and macular holes: complication analysis and systematic review with meta-analysis of functional outcomes. Int J Retina Vitreous 2023 December;9(1):1-16. https://doi.org/10.1186/s40942-023-00472-x
Steinle NC, Dhoot DS, Quezada Ruiz C, et al. Treatment of vitreomacular traction with intravitreal perfluoropropane (C3F8) injection. Retina 2017 April;37(4):643-650. https://doi.org/10.1097/ IAE.0000000000001237
Čokl N, Petrovič MG. Intravitreal injection of perfluoropropane is more efficacious than sulfur hexafluoride in releasing vitreomacular traction. Acta Clin Croat 2018;57(2):327-334. https://doi. org/10.20471/acc.2018.57.02.14
Gruchociak S, Djerada Z, Afriat M, et al. Compering intravitreal air and gas for the treatment of vitreomacular traction. Retina 2020 November;40(11):2140-2147. https://doi.org/10.1097/IAE.0000000000002733
Haller JA, Stalmans P, Benz MS, et al. Efficacy of intravitreal ocriplasmin for treatment of vitreomacular adhesion: Subgroup analyses from two randomized trials. Ophthalmology 2015 January;122(1):117-122. https://doi.org/10.1016/j.ophtha.2014.07.045
Feng HL, Roth DB, Hasan A, et al. Intravitreal ocriplasmin in clinical practice: Predictors of Success, Visual Outcomes, and Complications. Retina 2018 January;38(1):128-136. https://doi.org/10.1097/ IAE.0000000000001505
Baumann C, Sabatino F, Zheng Y, et al. Anatomical and functional outcomes of pneumatic vitreolysis for treatment of vitreomacular traction with and without macular holes. Graefes Arch Clin Exp Ophthalmol 2022 July;260(7):2209-2215. https://doi.org/10.1007/ s00417-022-05568-y
Neffendorf JE, Simpson ARH, Steel DHW, et al. Intravitreal gas for symptomatic vitreomacular adhesion: a synthesis of the literature. Acta Ophthalmol 2018 November;96(7):685-691. https://doi. org/10.1111/aos.13547
Enzymatic Vitreolysis with Ocriplasmin for Vitreomacular Traction and Macular Holes. N Engl JMed 2012 November;367(21):2052–2054. https://doi.org/10.1056/nejmc1211068
Chan CK, Mein CE, Glassman AR, et al. Pneumatic Vitreolysis with Perfluoropropane for Vitreomacular Traction with and without Macular Hole: DRCR Retina Network Protocols AG and AH. Ophthalmology 2021 November;128(11):1592-1603. https://doi.org/10.1016/j. ophtha.2021.05.005