Vitrectomy for macular pucker and vitreomacular traction syndrome

During the course of a so-called posterior vitreous detachment, a thin laye r of the posterior vitreous cortex often remains adherent to the underlying retina. Tangential stretch of this vitreous pseudomembrane may cause vitre omacular traction syndrome, edema, and macular hole formation. The same pro cess appears to underlie the development of true epimacular membranes (idio pathic macular pucker). Vitrectomy is generally agreed to be the most appro priate treatment for these clinical situations. We evaluated the incidence of vitreomacular adhesion and of visual improvement after vitrectomy of eye s with macular pucker (group 1; n=60) and vitreomacular traction syndrome ( group 2; n=50). Vitreomacular attachment was assessed during vitrectomy und er the condition of continuous air infusion. In the two groups, complete or partial vitreous attachment to the macula was observed in 57.4% and 74%, r espectively. We conclude that vitreomacular adhesion is a common feature of the two clinical situations. Visual improvement was achieved in 73% of bot h groups. High rates of postoperative visual acuities of 20/50 or better (6 0.6% in group-1; 65.7% in group-2 cases) occurred only in eyes with preoper ative values of 20/100 or better. It is reported that the visual outcome of vitreoretinal surgery for the two clinical conditions deteriorates with in creasing duration after initial manifestation. Vitrectomy should not be pos tponed in patients who complain of disturbing visual symptoms such as reduc ed visual acuity, metamorphopsia and disturbance of binocular reading.