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

Abstract

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.