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Date issued: October 2023 

Review date: October 2025 

Ref: A-465/WS/Ophthalmology/Vitreomacular Traction Syndrome v2

PDF:  Vitreomacular traction syndrome final October 2023 v2.pdf[pdf] 245KB

How to contact

The Royal Eye Infirmary

Telephone

Eye Urgent Care:  01752 439330

Eye Daycase Unit: 0845 439348

What is the macula?

Lining the inside of your eye is a thin sheet of nerves called the retina. The retina acts like the film in a camera by turning light entering your eye into a picture for your brain. The central part of the retina is called the macula. The macula is the most important part of the retina and is responsible for your best vision.

What is Vitreomacular Traction Syndrome?

Vitreomacular Traction Syndrome is a condition where there is an unusually strong attachment between the vitreous gel and the very centre of the retina. The central retina is therefore lifted up slightly and does not function properly, resulting in reduced and distorted central vision.

What are the treatment options?

There are 4 main options:

1. No treatment - In which case you would expect one of the following three scenarios.

• Spontaneous resolution, may occur in 10% of cases within a few months.

• Persistence, in the majority of cases. Resulting in vision either staying the same, or getting worse.

• Progression to a macular hole, with associated further reduction in vision.

        2. Vitrectomy Surgery

        3. Ocriplasmin Injection

        4. Pneumatic Release

What is Vitrectomy Surgery?

This is an operation that is usually carried out under a local anaesthetic as a day-case. Three tiny incisions are made around the eye, through which the vitreous gel is removed from the eye and replaced with clear fluid. As a result, there will no longer be any vitreous gel to pull on the retina.

This surgery is guaranteed to resolve the vitreomacular traction.

There is a 20% chance that we will need to leave a bubble of special gas inside your eye. In which case we will ask you to carry out posturing, whereby you would be required to keep your head in a particular position for most of the time, for up to 2 weeks following surgery.

The main risks of vitrectomy surgery are

• All patients who have not previously had cataract surgery will develop a cataract more rapidly.

• One in a thousand chance of loss of vision from a severe eye infection.

• One in a thousand chance of loss of vision from severe eye bleeding.

• One in twenty chance of developing a retinal detachment.

Ocriplasmin Injection

Ocriplasmin is derived from the human enzyme plasmin and works against the molecules (known as fibronectin, laminin and collagen) that attach the retina to the vitreous gel.

The procedure involves a simple short one-off injection of Ocriplasmin into the eyeball itself. It is carried out under local anaesthetic as a day-case or outpatient procedure.

We expect Ocriplasmin to be successful in treating Vitreomacular Traction Syndrome within 28 days in approximately 37% of NHS approved cases.

What can I expect after the Ocriplasmin injection?

We will prescribe antibiotic drops to use in your eye for approximately one week. Your eye may be slightly red, sore and gritty for a few days.

The following other side effects may occur: vitreous floaters, blurred vision, raised eye pressure, visual distortion, photophobia, colour vision disturbance, retinal tears and retinal detachment. A very rare complication with any intraocular injection is loss of vision.

How much vision can I expect after treatment?

For patients with vitreomacular traction syndrome we expect after 6 months a 25% chance of gaining at least 10 letters, and a 7% chance of losing at least 10 letters.

What happens if the Ocriplasmin does not work?

You would be offered the chance to have vitrectomy surgery to relieve the vitreomacular traction. 

Pneumatic Release

This procedure involves a simple short one-off injection of a special gas bubble into the eyeball. It is carried out under local anaesthetic as a day-case or outpatient procedure.

Following the injection there is no specific posture. However, you may be asked to simulate reading.

Injecting gas into eyes has been carried out for decades for other eye conditions. However, we have only recently started using it for this condition. We expect the success rate to be approximately 80%.

What can I expect after the gas injection?

We will prescribe antibiotic drops to use in your eye for approximately one week. Your eye may be slightly red, sore and gritty for a few days.

You will initially notice multiple dark bubbles in your vision, which will enlarge and come together over a period of three days. After that the bubble will gradually shrink and finally disappear over approximately six weeks

The following other side effects may occur: vitreous floaters, blurred vision, raised eye pressure, retinal tears and retinal detachment. A very rare complication with any intraocular injection is loss of vision.

What happens if the gas injection does not work?

You would be offered the chance to have vitrectomy surgery or another gas injection to relieve the vitreomacular traction

Acknowledgements:

Based on:

RNIB & RCOphth Booklet Understanding Retinal Detachment 2001

Diagram:

National Eye Institute

National Institutes for Health USA

Thrombogenics website

EyeWiki website