Frequency of Vitreo-Macular Traction in Patients with Diabetic Macular Edema Using Spectral-Domain Optical Coherence Tomography
DOI:
https://doi.org/10.71000/ekdj9739Keywords:
Diabetic macular edema; vitreo-macular traction; optical coherence tomography; vitreoretinal interface.Abstract
Objective: To determine the frequency of vitreo-macular traction (VMT) in patients with diabetic macular edema (DME) using spectral-domain optical coherence tomography (SD-OCT).
Study Design: Descriptive, cross-sectional study.
Place and Duration: Department of Ophthalmology, Allama Iqbal Medical College/Jinnah Hospital, Lahore, from 21 December 2020 to 20 June 2021.
Methods: One hundred and ten patients with DME, aged 20–70 years, of either gender, were enrolled by non-probability consecutive sampling. Patients with a history of vitreoretinal surgery, another retinal vascular disease, pan-retinal photocoagulation or grid laser within the preceding three months, or known glaucoma (intraocular pressure >21 mmHg) were excluded. Following pupillary dilatation, SD-OCT (Topcon 3D OCT-1000) was performed with a 6×6 mm macular scan protocol comprising 64 B-scans. For this study, DME was operationally defined as central macular thickness (CMT) >250 µm. VMT was identified as persistent vitreomacular attachment associated with tractional distortion, tissue elevation, or deformation of the macular contour. Continuous variables were summarized as mean ± standard deviation and categorical variables as frequency and percentage. Pearson chi-square testing was used for prespecified subgroup comparisons; p<0.05 was considered statistically significant.
Results: The mean age was 51.26 ± 9.44 years; 56 (50.91%) participants were male and 54 (49.09%) were female. Mean duration of diabetes was 13.37 ± 5.21 years and mean CMT was 383.17 ± 77.57 µm. VMT was identified in 38 of 110 patients (34.55%; 95% CI 26.3%–43.8%). No statistically significant association was detected between VMT and age (p=0.862), gender (p=0.062), duration of diabetes (p=0.861), or CMT (p=0.824).
Conclusion: VMT was identified in approximately one-third of patients with DME in this cohort. The vitreomacular interface should therefore be assessed carefully on SD-OCT in patients with DME, particularly because tractional abnormalities may influence treatment planning and response.
References
Flaxel CJ, Adelman RA, Bailey ST, Fawzi A, Lim JI, Vemulakonda GA, Ying GS. Diabetic Retinopathy Preferred Practice Pattern®. Ophthalmology. 2020;127(1):P66-P145. doi:10.1016/j.ophtha.2019.09.025.
Udaondo P, Parravano M, Vujosevic S, Zur D, Chakravarthy U. Update on current and future management for diabetic maculopathy. Ophthalmol Ther. 2022;11(2):489-502. doi:10.1007/s40123-022-00460-8.
Teo ZL, Tham YC, Yu M, Chee ML, Rim TH, Cheung N, et al. Global prevalence of diabetic retinopathy and projection of burden through 2045: systematic review and meta-analysis. Ophthalmology. 2021;128(11):1580-1591. doi:10.1016/j.ophtha.2021.04.027.
Duker JS, Kaiser PK, Binder S, de Smet MD, Gaudric A, Reichel E, et al. The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole. Ophthalmology. 2013;120(12):2611-2619. doi:10.1016/j.ophtha.2013.07.042.
Gong Y, Wang M, Li Q, Shao Y, Li X. Evaluating the effect of vitreomacular interface abnormalities on anti-vascular endothelial growth factor treatment outcomes in diabetic macular edema by optical coherence tomography: a systematic review and meta-analysis. Photodiagnosis Photodyn Ther. 2023;42:103555. doi:10.1016/j.pdpdt.2023.103555.
Shao L, Zhang C, Dong L, Zhou WD, Zhang RH, Wei WB. Prevalence and associations of vitreomacular traction: the Beijing Eye Study. Int J Gen Med. 2021;14:7059-7064. doi:10.2147/IJGM.S333010.
Mikhail M, Stewart S, Seow F, Hogg R, Lois N. Vitreomacular interface abnormalities in patients with diabetic macular oedema and their implications on the response to anti-VEGF therapy. Graefes Arch Clin Exp Ophthalmol. 2018;256(8):1411-1418. doi:10.1007/s00417-018-4009-6.
Kulikov AN, Sosnovskii SV, Berezin RD, Maltsev DS, Oskanov DH, Gribanov NA. Vitreoretinal interface abnormalities in diabetic macular edema and effectiveness of anti-VEGF therapy: an optical coherence tomography study. Clin Ophthalmol. 2017;11:1995-2002. doi:10.2147/OPTH.S146019.
Fatima N, Ul Islam Q, Shafique M. Frequency of vitreo-macular traction in diabetic macular edema on optical coherence tomography. Pak Armed Forces Med J. 2017;67(1):47-50.
Arf S, Sayman Muslubas I, Hocaoglu M, Ersoz MG, Ozdemir H, Karacorlu M. Spectral domain optical coherence tomography classification of diabetic macular edema: a new proposal to clinical practice. Graefes Arch Clin Exp Ophthalmol. 2020;258(6):1165-1172. doi:10.1007/s00417-020-04640-9.
Basit A, Fawwad A, Qureshi H, Shera AS; NDSP Members. Prevalence of diabetes, pre-diabetes and associated risk factors: second National Diabetes Survey of Pakistan (NDSP), 2016-2017. BMJ Open. 2018;8(8):e020961. doi:10.1136/bmjopen-2017-020961.
Elkayal H, Bedda AM, El-Goweini H, Souka AA, Gomaa AR. Pars plana vitrectomy versus intravitreal injection of ranibizumab in the treatment of diabetic macular edema associated with vitreomacular interface abnormalities. J Ophthalmol. 2021;2021:6699668. doi:10.1155/2021/6699668.
Hsieh TC, Deng GH, Chang YC, Chang FL, He MS. A real-world study for timely assessing the diabetic macular edema refractory to intravitreal anti-VEGF treatment. Front Endocrinol (Lausanne). 2023;14:1108097. doi:10.3389/fendo.2023.1108097.
Ito Y, Takatsudo Y, Gehlbach PL, Mori K. Mechanistic insights into the pathogenesis of proliferative and nonproliferative vitreomacular traction. Am J Ophthalmol. 2022;238:1-9. doi:10.1016/j.ajo.2021.11.026.
Garg A, Popovic MM, Cioana M, Ballios BG, Brent MH, Hurley B, Kertes PJ, Yan P. Predictive factors of spontaneous release of vitreomacular traction: a systematic review and meta-analysis. Retina. 2022;42(7):1219-1230. doi:10.1097/IAE.0000000000003513.
Petrou P, Chalkiadaki E, Errera MH, Liyanage S, Wickham L, Papakonstantinou E, et al. Factors associated with the clinical course of vitreomacular traction. J Ophthalmol. 2020;2020:9457670. doi:10.1155/2020/9457670.
Maggio E, Mete M, Sartore M, Bauci F, Guerriero M, Polito A, Pertile G. Temporal variation of optical coherence tomography biomarkers as predictors of anti-VEGF treatment outcomes in diabetic macular edema. Graefes Arch Clin Exp Ophthalmol. 2022;260(3):807-815. doi:10.1007/s00417-021-05387-7.
Fukumoto M, Sato T, Oosuka S, Kida T, Oku H, Ikeda T. Clinical features of vitreomacular traction syndrome with peripheral vitreoretinal adhesion. Clin Ophthalmol. 2020;14:281-286. doi:10.2147/OPTH.S235670.
Al Qassimi N, Kozak I, Al Karam M, Neri P, Aduriz-Lorenzo PM, Attawan A, et al. Management of diabetic macular edema: guidelines from the Emirates Society of Ophthalmology. Ophthalmol Ther. 2022;11(5):1937-1950. doi:10.1007/s40123-022-00547-2.
Flaxel CJ, Adelman RA, Bailey ST, Fawzi A, Lim JI, Vemulakonda GA, Ying GS. Idiopathic epiretinal membrane and vitreomacular traction Preferred Practice Pattern®. Ophthalmology. 2020;127(2):P145-P183. doi:10.1016/j.ophtha.2019.09.022.
Chan CK, Mein CE, Glassman AR, Beaulieu WT, Calhoun CT, Jaffe GJ, et al.; DRCR Retina Network. Pneumatic vitreolysis with perfluoropropane for vitreomacular traction with and without macular hole: DRCR Retina Network Protocols AG and AH. Ophthalmology. 2021;128(11):1592-1603. doi:10.1016/j.ophtha.2021.05.005.
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Copyright (c) 2025 Dr. Muhammad Hassan Aftab, Dr. Mohammad Ahmed Imran, Dr. Muhammad Nauraiz Zubair Chawla, Dr. Muhammad Hamza Tariq, Dr. Bushra Nawaz (Author)
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