Intravitreal injection of C<sub>3</sub>F<sub>8</sub> in the treatment of vitreomacular traction syndrome_Chinese Journal of Ocular Fundus Diseases

Authors：

Zeng Miao ,  Chen Xiao , Hong Ling , Cai Chunyan , Yan Yin , Huang Zhijian

Department of Ophthalmology, Central Theater Command General Hospital, Wuhan 430070, China;

Corresponding author：

Chen Xiao, Email: cxwhzyyykzr2015@163.com

Keywords：

Noble gases/therapeutic use; Treatment outcome; Vitreomacular traction syndrome

DOI：

10.3760/cma.j.issn.1005-1015.2019.03.011

Video：

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Objective To evaluate the efficacy of single intravitreal injection of C₃F₈ in treating vitremacular traction (VMT) syndrome.Methods A retrospective case series of 38 eyes of 36 patients affected with VMT syndrome in Department of Ophthalmology, Central Theater Command General Hospital from March 2016 to June 2017 were enrolled in this study. There were 16 males (16 eyes) and 20 females (22 eyes), with the mean age of 64.11±9.49 years and the mean courses of 151.55±127.87 days. All the patients received an intravitreal injection of 0.3 ml of 100% C₃F₈ within one week. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. The severity of metamorphopsia was detected using M-charts. The extent of vitreomacular adhesion (VMA), central macular thickness (CMT) and the status of ellipsoid zone (EZ) were assessed with spectral-domain OCT at baseline and each month after treatment. The average BCVA was 0.58±0.22. The mean horizontal metamorphopsia (MH) and vertical metamorphopsia (MV) were 0.34±0.30 and 0.50±0.42, respectively. The mean CMT was 415.15±89.59 μm. The mean horizontal VMA was 1168.68±400.61 μm (30 eyes with VMA≤1500 μm and 8 eyes with VMA＞1500 μm). The mean vertical VMA was 976.89±295.92 μm. There were 22 eyes with integrity EZ and 16 eyes without integrity EZ, 33 eyes with crystalline lens and 5 eyes with IOL. The mean follow-up time was 10.7 months. The differences in BCVA, MH, MV, CMT, the integrity of EZ before and after treatment were analyzed. The VMT release rates were assessed. The Spearman rank correlation analysis was performed to investigate the relationship of VMT release rates with the data at baseline.Results Vitreomacular traction release occurred in 29 of 38 eyes by the final follow-up visit, the VMT release rate was 76.3%. VMT release occurred and the average time of VMT release occurred was 2.2 weeks. VMT persisted in 7 eyes, in the rest two eyes, one eye developed a retinal detachment and another eye formed macular hole, both eyes responded to vitrectomy. At 6 months after treatment, the average logMAR BCVA was 0.43±0.23, the mean MH and MV were 0.25±0.23 and 0.24±0.23, the mean CMT was 310.61±63.10 μm. Among 16 eyes without integrity EZ before treatment, there were 9 eyes with integrity EZ at 6 months after treatment. There were 16 eyes with integrity EZ and 9 Compared with baseline, the mean BCVA at 6 months after treatment was significantly increased (F=3.779, P=0.037), but the MV (F=4.958, P =0.003) and CMT (F=13.419, P＜0.001) were significantly decreased, the integrity of EZ was improved significantly (χ²=5.050, P=0.025). The VMT release correlated inversely with the extent of horizontal VMA, BCVA, and CMT at baseline (r=-0.514, -0.348, -0.429; P=0.009, 0.001, 0.038).Conclusion Intravitreal injection of C₃F₈ can induce a posterior vitreous detachment and release vitreomacular traction, it is an efficient and safe treatment for VMT syndrome. It can improve the visual acuity, metamorphopsia and foveal morphology in patients with VMT syndrome.

Citation： Zeng Miao, Chen Xiao, Hong Ling, Cai Chunyan, Yan Yin, Huang Zhijian. Intravitreal injection of C₃F₈ in the treatment of vitreomacular traction syndrome. Chinese Journal of Ocular Fundus Diseases, 2019, 35(3): 263-268. doi: 10.3760/cma.j.issn.1005-1015.2019.03.011 Copy

1.	Chang LK, Fine HF, Spaide RF, et al. Ultrastructural correlation of spectral-domain optical coherence tomographic findings in vitreomacular traction syndrome[J]. Am J Ophthalmol, 2008, 146(1): 121-127. DOI: 10.1016/j.ajo.2008.03.001.
2.	Johnson MW. Posterior vitreous detachment: evolution and complications of its early stages[J]. Am J Ophthalmol, 2010, 149(3): 371-382. DOI: 10.1016/j.ajo.2009.11.022.
3.	Sebag J. Anomalous posterior vitreous detachment: a unifying concept in vitreo-retinal disease[J]. Graefe’s Arch Clin Exp Ophthalmol, 2004, 242(8): 690-698. DOI: 10.1007/s00417-004-0980-1.
4.	Steel DH, Lotery AJ. Idiopathic vitreomacular traction and macular hole: a comprehensive review of pathophysiology, diagnosis, and treatment[J]. Eye(Lond), 2013, 27 Suppl 1: S1-21. DOI: 10.1038/eye.2013.212.
5.	Johnson MW. How should we release vitreomacular traction: surgically, pharmacologically, or pneumatically?[J]. Am J Ophthalmol, 2013, 155(2): 203-205. DOI: 10.1016/j.ajo.2012.10.016.
6.	Hikichi T, Yoshida A, Trempe CL. Course of vitreomacular traction syndrome[J]. Am J Ophthalmol, 1995, 119(1): 55-61. DOI: 10.1016/s0002-9394(14)73813-9.
7.	Errera MH, Liyanage SE, Petrou P, et al. A Study of the natural history of vitreomacular traction syndrome by OCT[J]. Ophthalmology, 2018, 125(5): 701-707. DOI: 10.1016/j.ophtha.2017.10.035.
8.	Sayegh RG, Georgopoulos M, Geitzenauer W, et al. High-resolution optical coherence tomography after surgery for vitreomacular traction: a 2-year follow-up[J]. Ophthalmology, 2010, 117(10): 2010-2017. DOI: 10.1016/j.ophtha.2010.01.041.
9.	Rodrigues IA, Stangos AN, McHugh DA, et al. Intravitreal Injection of expansile perfluoropropane (C₃F₈) for the treatment of vitreomacular traction[J]. Am J Ophthalmol, 2013, 155(2): 270-276. DOI: 10.1016/j.ajo.2012.08.018.
10.	Chan CK, Crosson JN, Mein CE, et al. Pneumatic vitreolysis for relief of vitreomacular traction[J]. Retina, 2017, 37(10): 1820-1831. DOI: 10.1097/iae.0000000000001448.
11.	Steinle NC, Dhoot DS, Ruiz CQ, et al. Treatment of vitreomacular traction with intravitreal perfluoropropane (C₃F₈) injection[J]. Retina, 2017, 37(4): 643-650. DOI: 10.1097/iae.0000000000001237.
12.	Duker J, Kaiser PK, Binder S, et al. The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole[J]. Ophthalmology, 2013, 120(12): 2611-2619. DOI: 10.1016/j.ophtha.2013.07.042.
13.	曾苗, 陈晓, 洪玲, 等. 特发性黄斑前膜患眼玻璃体切割联合内界膜剥除手术前后视力视物变形度与黄斑形态结构的相关性[J]. 中华眼底病杂志, 2017, 33(4): 378-382. DOI: 10.3760/cma.j.issn.1005-1015.2017.04.Zeng M, Chen X, Hong L, et al. Correlation of visual acuity and metamorphopsia with foveal morphology before and after vitrectomy with internal limiting membrane peeling in idiopathic macular epiretinal membrane eyes[J]. Chin J Ocul Fundus Dis, 2017, 33(4): 378-382. DOI: 10.3760/cma.j.issn.1005-1015.2017.04.
14.	Singh RP, Li A, Bedi R, et al. Anatomical and visual outcomes following ocriplasmin treatment for symptomatic vitreomacular traction syndrome[J]. Br J Ophthalmol, 2014, 98(4): 356-360. DOI: 10.1136/bjophthalmol-2013-304219.
15.	Chan CK, Wessels IF, Friedrichsen EJ. Treatment of idiopathic macular holes by induced posterior vitreous detachment[J]. Ophthalmology, 1995, 102(5): 757-767. DOI: 10.1016/s0161-6420(95)30958-x.
16.	Mori K, Saito S, Gehlbach PL, et al. Treatment of stage 2 macular hole by intravitreous injection of expansile gas and induction of posterior vitreous detachment[J]. Ophthalmology, 2007, 114(1): 127-133. DOI: 10.1016/j.ophtha.2006.07.001.
17.	Day S, Martinez JA, Nixon PA, et al. Intravitreal sulfur hexafluoride injection for the treatment of vitreomacular traction syndrome[J]. Retina, 2016, 36(4): 733-737. DOI: 10.1097/iae.0000000000000760.
18.	McHugh D, Gupta B, Saeed M. Intravitreal gas injection for the treatment of diabetic macular edema[J]. Clin Ophthalmol, 2011, 5(10): 1543-1548. DOI: 10.2147/opth.s25348.
19.	Dugel PU, Tolentino M, Feiner L, et al. Results of the 2-year ocriplasmin for treatment for symptomatic vitreomacular adhesion including macular hole (OASIS) randomized trial[J]. Ophthalmology, 2016, 123(10): 2232-2247. DOI: 10.1016/j.ophtha.2016.06.043.
20.	Park KA, Kim J, Oh SY. Analysis of spectral domain optical coherence tomography measurements in optic neuritis: differences in neuromyelitis optica, multiple sclerosis, isolated optic neuritis and normal healthy controls[J]. Acta Ophthalmol, 2014, 92(1): 57-65. DOI: 10.1111/aos.12215.
21.	Roberto DO, Mura M. Metamorphopsia and optical coherence tomography findings after rhegmatogenous retinal detachment surgery[J]. Am J Ophthalmol, 2014, 157(6): 1322-1323. DOI: 10.1016/j.ajo.2014.02.024.
22.	Okamoto F, Sugiura Y, Okamoto Y, et al. Inner nuclear layer thickness as a prognostic factor for metamorphopsia after epiretinal membrane surgery[J]. Retina, 2015, 35(10): 2107-2114. DOI: 10.1097/IAE.0000000000000602.
23.	Jackson TL, Nicod E, Angelis A, et al. Pars plana vitrectomy for vitreomacular traction syndrome: a systematic review and metaanalysis of safety and efficacy[J]. Retina, 2013, 33(10): 2012-2017. DOI: 10.1097/IAE.0b013e3182a6b3e2.
24.	Feng H, Adelman R. Cataract formation following vitreoretinal procedures[J]. Clin Ophthalmol, 2014, 8(9): 1957-1965. DOI: 10.2147/OPTH.S68661.

1. Chang LK, Fine HF, Spaide RF, et al. Ultrastructural correlation of spectral-domain optical coherence tomographic findings in vitreomacular traction syndrome[J]. Am J Ophthalmol, 2008, 146(1): 121-127. DOI: 10.1016/j.ajo.2008.03.001.
2. Johnson MW. Posterior vitreous detachment: evolution and complications of its early stages[J]. Am J Ophthalmol, 2010, 149(3): 371-382. DOI: 10.1016/j.ajo.2009.11.022.
3. Sebag J. Anomalous posterior vitreous detachment: a unifying concept in vitreo-retinal disease[J]. Graefe’s Arch Clin Exp Ophthalmol, 2004, 242(8): 690-698. DOI: 10.1007/s00417-004-0980-1.
4. Steel DH, Lotery AJ. Idiopathic vitreomacular traction and macular hole: a comprehensive review of pathophysiology, diagnosis, and treatment[J]. Eye(Lond), 2013, 27 Suppl 1: S1-21. DOI: 10.1038/eye.2013.212.
5. Johnson MW. How should we release vitreomacular traction: surgically, pharmacologically, or pneumatically?[J]. Am J Ophthalmol, 2013, 155(2): 203-205. DOI: 10.1016/j.ajo.2012.10.016.
6. Hikichi T, Yoshida A, Trempe CL. Course of vitreomacular traction syndrome[J]. Am J Ophthalmol, 1995, 119(1): 55-61. DOI: 10.1016/s0002-9394(14)73813-9.
7. Errera MH, Liyanage SE, Petrou P, et al. A Study of the natural history of vitreomacular traction syndrome by OCT[J]. Ophthalmology, 2018, 125(5): 701-707. DOI: 10.1016/j.ophtha.2017.10.035.
8. Sayegh RG, Georgopoulos M, Geitzenauer W, et al. High-resolution optical coherence tomography after surgery for vitreomacular traction: a 2-year follow-up[J]. Ophthalmology, 2010, 117(10): 2010-2017. DOI: 10.1016/j.ophtha.2010.01.041.
9. Rodrigues IA, Stangos AN, McHugh DA, et al. Intravitreal Injection of expansile perfluoropropane (C₃F₈) for the treatment of vitreomacular traction[J]. Am J Ophthalmol, 2013, 155(2): 270-276. DOI: 10.1016/j.ajo.2012.08.018.
10. Chan CK, Crosson JN, Mein CE, et al. Pneumatic vitreolysis for relief of vitreomacular traction[J]. Retina, 2017, 37(10): 1820-1831. DOI: 10.1097/iae.0000000000001448.
11. Steinle NC, Dhoot DS, Ruiz CQ, et al. Treatment of vitreomacular traction with intravitreal perfluoropropane (C₃F₈) injection[J]. Retina, 2017, 37(4): 643-650. DOI: 10.1097/iae.0000000000001237.
12. Duker J, Kaiser PK, Binder S, et al. The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole[J]. Ophthalmology, 2013, 120(12): 2611-2619. DOI: 10.1016/j.ophtha.2013.07.042.
13. 曾苗, 陈晓, 洪玲, 等. 特发性黄斑前膜患眼玻璃体切割联合内界膜剥除手术前后视力视物变形度与黄斑形态结构的相关性[J]. 中华眼底病杂志, 2017, 33(4): 378-382. DOI: 10.3760/cma.j.issn.1005-1015.2017.04.Zeng M, Chen X, Hong L, et al. Correlation of visual acuity and metamorphopsia with foveal morphology before and after vitrectomy with internal limiting membrane peeling in idiopathic macular epiretinal membrane eyes[J]. Chin J Ocul Fundus Dis, 2017, 33(4): 378-382. DOI: 10.3760/cma.j.issn.1005-1015.2017.04.
14. Singh RP, Li A, Bedi R, et al. Anatomical and visual outcomes following ocriplasmin treatment for symptomatic vitreomacular traction syndrome[J]. Br J Ophthalmol, 2014, 98(4): 356-360. DOI: 10.1136/bjophthalmol-2013-304219.
15. Chan CK, Wessels IF, Friedrichsen EJ. Treatment of idiopathic macular holes by induced posterior vitreous detachment[J]. Ophthalmology, 1995, 102(5): 757-767. DOI: 10.1016/s0161-6420(95)30958-x.
16. Mori K, Saito S, Gehlbach PL, et al. Treatment of stage 2 macular hole by intravitreous injection of expansile gas and induction of posterior vitreous detachment[J]. Ophthalmology, 2007, 114(1): 127-133. DOI: 10.1016/j.ophtha.2006.07.001.
17. Day S, Martinez JA, Nixon PA, et al. Intravitreal sulfur hexafluoride injection for the treatment of vitreomacular traction syndrome[J]. Retina, 2016, 36(4): 733-737. DOI: 10.1097/iae.0000000000000760.
18. McHugh D, Gupta B, Saeed M. Intravitreal gas injection for the treatment of diabetic macular edema[J]. Clin Ophthalmol, 2011, 5(10): 1543-1548. DOI: 10.2147/opth.s25348.
19. Dugel PU, Tolentino M, Feiner L, et al. Results of the 2-year ocriplasmin for treatment for symptomatic vitreomacular adhesion including macular hole (OASIS) randomized trial[J]. Ophthalmology, 2016, 123(10): 2232-2247. DOI: 10.1016/j.ophtha.2016.06.043.
20. Park KA, Kim J, Oh SY. Analysis of spectral domain optical coherence tomography measurements in optic neuritis: differences in neuromyelitis optica, multiple sclerosis, isolated optic neuritis and normal healthy controls[J]. Acta Ophthalmol, 2014, 92(1): 57-65. DOI: 10.1111/aos.12215.
21. Roberto DO, Mura M. Metamorphopsia and optical coherence tomography findings after rhegmatogenous retinal detachment surgery[J]. Am J Ophthalmol, 2014, 157(6): 1322-1323. DOI: 10.1016/j.ajo.2014.02.024.
22. Okamoto F, Sugiura Y, Okamoto Y, et al. Inner nuclear layer thickness as a prognostic factor for metamorphopsia after epiretinal membrane surgery[J]. Retina, 2015, 35(10): 2107-2114. DOI: 10.1097/IAE.0000000000000602.
23. Jackson TL, Nicod E, Angelis A, et al. Pars plana vitrectomy for vitreomacular traction syndrome: a systematic review and metaanalysis of safety and efficacy[J]. Retina, 2013, 33(10): 2012-2017. DOI: 10.1097/IAE.0b013e3182a6b3e2.
24. Feng H, Adelman R. Cataract formation following vitreoretinal procedures[J]. Clin Ophthalmol, 2014, 8(9): 1957-1965. DOI: 10.2147/OPTH.S68661.

Chinese Journal of Ocular Fundus Diseases

Intravitreal injection of C₃F₈ in the treatment of vitreomacular traction syndrome

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Intravitreal injection of C3F8 in the treatment of vitreomacular traction syndrome

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Intravitreal injection of C₃F₈ in the treatment of vitreomacular traction syndrome