Optical Coherence Tomography with Angiography in the Analysis of Vitrectomy Effectiveness in Patients with Vitreomacular Traction Syndrome

Micro incision vitrectomy surgery with removal of epiretinal and internal limiting membranes is used for treating various forms of vitreomacular traction syndrome.

Objective: to study the condition of retinal microcirculation using the OCTA method in the patients with traction maculopathy and macular ruptures before and after vitrectomy.

Patients and Methods. The study included 160 patients, of which 55 had epiretinal fibrosis (Treatment 1), 60 had macular ruptures (Treatment 2), and 45 with no ophthalmic pathology (Control). Treatment 2 group included two subgroups: 2a — patients with large-diameter ruptures (over 800 μm) subject to inverted internal limiting membrane flap technique (n = 12), and 2b — patients with 430–800 μm ruptures subject to rapprochement of the rupture edges with a platelet mass technique. All patients underwent conventional ophthalmology examinations and optical coherence tomography angiography (OCTA) using Sirrus HD-OCT 5000, Carl Zeiss, Germany.

Results. In the postoperative period, there was an improvement in retinal microcirculation in the Treatment 1 patients, and the values of both perfusion and vascular densities increased. A month later, an additional improvement of these indicators was recorded against the background of a decrease in retinal thickness and restoration of the vitreoretinal interface configuration. In the early postoperative period, Treatment 2 patients showed significant difference in the capillary density of the superficial vascular complex from the control group. A month later, the density of blood vessels in the Treatment 2 patients achieved control group values. Despite an immediate increase in perfusion measurements after surgical treatment, their values in a month were still lower than in the control group.

Conclusions. In the patients with epiretinal membrane and macular ruptures, a statistically significant decrease in both vascular and perfusion densities of the surface capillary complex was revealed by OCTA. The effects of vitreoretinal surgery performed on Treatment 1 and 2 patients with macula traction pathology included increased visual acuity, decreased retinal thickness, and restoration of the proper vitreoretinal profile. Based on OCTA results, we discovered a gradual increase in vascular density of the macula in Treatment 1 and 2 patients after surgical treatment of VMT syndrome. Retinal perfusion in the macular region of Treatment 1 patients achieved the values of the control group within a month, while in Treatment 2 patients they increased, but remained lower than in control group. OCTA is a highly informative method for the diagnostics and monitoring of the eye posterior segment condition in the patients with VMT syndrome.

1. Aznabaev B.M., Muhamadeev T.R., Dibaev T.I. Evaluation of vitreomacular traction syndrome using spectral optical coherence tomography. Bashkortostan Medical Journal = Meditsinskiy vestnik Bashkortostana. 2014;9(2):107–109 (In Russ.).

2. Sebag J. Vitreous in Health and Disease. New York. 2014. P. 925.

3. Hangai M., Ojima Y., Gotoh N. Three-dimensional imaging of macular holes with high-speed optical coherence tomography. Ophthalmology. 2007;114(4):763–773. DOI: 10.1016/j.ophtha.2006.07.055

4. Gorshkov I.M., Kolesnik S.V., Shestopalov V.I., Miridonova A.V. Clinical-morphological characteristics of cell composition of idiopathic epiretinal membranes in patients with various visual acuity. Fyodorov Journal of Ophthalmic Surgery = Oftal’mokhirurgiya. 2017;(2):6–11 (In Russ.). DOI: 10.25276/0235-4160-2017-2

5. García-Layana A., García-Arumí J., Ruiz-Moreno J., Arias-Barquet L. A Review of Current Management of Vitreomacular Traction and Macular Hole. J. Ophthalmol. 2015;2015:809640. DOI: 10.1155/2015/809640

6. Charalampidou S., Nolan J., Beatty S. The natural history of tractional сystoid macular edema. Retina. 2012;32(10):2045–2051. DOI: 10.1097/IAE.0b013e3182561fe6

7. Hakura H., Kishi S. Aging changes of vitreo-macular interface. Retina. 2011;31(7):1400–1404. DOI: 10.1097/IAE.0b013e318206cb43

8. Machado L., Furlani B., Navarro R. Preoperative and intraoperative prognostic factors of epiretinal membranes using chromovitrectomy and internal limiting membrane peeling. Ophthalmic Surg Lasers Imaging Retina. 2016;46(4):457–462. DOI: 10.3928/23258160-20150422-09

9. Toquetto D., Grandin R., Sarguietti G. Internal limiting membrane removal during macular hole surgery: Results of a multicenter study. Ophthalmology. 2006;113:1401–1410. DOI: 10.1016/j.ophtha.2006.02.061

10. Berrod J.P., Poirson A. Which epiretinal membranes should be operated. Fr. Ophthalmol. 2008;31:192–199. DOI: 10.1016/s0181-5512(08)70356-5

11. Roth A.M., Foos R.Y. Surface wrinkling retinopathy in eye enucleated at autopsy. Trans Am. Acad. Ophthalmol. 1971;75:1047–1059.

12. Kachalina G.F., Doga A.V., Kasmynina T.A., Kuranova O.I. Epiretinal fibrosis: pathogenesis, outcomes, treatment methods. Fyodorov Journal of Ophthalmic Surgery = Oftal’mokhirurgiya. 2013;4:108–110 (In Russ.).

13. Daurov S.K., Dolinina O.N., Kamenskikh T.G., Batischeva Yu.S., Kolbenev I.O., Andreychenko O.A., Potemkin S.A., Proskudin R.A. Computer analysis of epiretinal membrane parameters. Saratov Journal of Medical Scientific Research = Saratovskii nauchno-meditsinskii zhurnal. 2017;13(2):350–358 (In Russ.).

14. Snead D.R., James S., Snead M.P. Pathological changes in the vitreoretinal junction 1: epiretinal membrane formation. Eye. 2008;22(10):1310–1317. DOI: 10.1038/ eye.2008.36

15. Bu S.C., Kuijer R., van der Worp R.J. Immunohistochemical Evaluation of Idiopathic Epiretinal Membranes and In Vitro Studies on the Effect of TGF-β on Muller Cells iERMs, Muller Cells, and TGF-β. Invest. Ophthalmol. Vis. Sci. 2015;56(11):6506– 6514. DOI: 10.1167/iovs.14-15971

16. Shkvorchenko D.O., Zakharov V.D., Rusanovskaya A.V. Comparative analysis of vitreofoveolar traction syndrome surgical treatment. Ophthalmology journal = Oftal’mologicheskie vedomosti. 2014;7(3):28–33 (In Russ.).

17. Hisatomi T., Enaida H., Sakamoto T., et al. A new method for comprehensive bird’ s-eye analysis of the surgically excised internal limiting membrane. Am J Ophthalmol. 2005;139(6):1121–1122. DOI: 10.1016/j.ajo.2004.11.051

18. Lumbroso B., Huang D., Jia Y., Fujimoto J.A., Rispoli M. Clinical guide to AngioOCT. Jjaypee. 2014.

19. Richard F. Spaide. Volume-rendered angiographic and structural optical сoherent tomography. Retina. 2015;35(11):2181–2187. DOI: 10.1097/IAE.0000000000000764