May 2015 · Vol. 46, No. 5 571 ■ CLINICAL SCIENCE ■ Clinical Course of Vitreomacular Traction Managed Initially by Observation Jonathan H. Tzu, MD; Vishak J. John, MD; Harry W. Flynn Jr., MD; William E. Smiddy, MD; Jared R. Jackson, MD; Blake A. Isernhagen, MD; Adam Carver, MD; Robert Leonard, MD; Homayoun Tabandeh, MD; David S. Boyer, MD; Maria H. Berrocal, MD; Mihoko Suzuki, MD; K. Bailey Freund, MD; Jeffrey G. Gross, MD BACKGROUND AND OBJECTIVE: To investigate the clinical course and outcomes of patients with vit- reomacular traction (VMT) managed initially by observation. PATIENTS AND METHODS: This noncomparative case series included patients with a diagnosis of VMT based on clinical symptoms and findings on spectral- domain optical coherence tomography (SD-OCT) be- tween 2005 and 2014. VMT was documented using a standardized grading system based on the degree of distortion of the foveal contour. Data were collected at five retina clinics using standardized collection forms. Visual acuity, changes in SD-OCT findings, and timing of the release of VMT as seen on SD-OCT were recorded. RESULTS: The study included 230 eyes of 185 patients. Mean age was 72.5 years, and mean follow-up was 32 months. At baseline, VMT grading was grade 1 in 92 eyes (40%), grade 2 in 118 eyes (51.3%), and grade 3 in 20 eyes (8.7%). By last follow-up, spontaneous re- lease of VMT occurred in 73 eyes (31.7%). Spontane- ous release of VMT occurred at a mean of 18 months (median: 10.9 months) after initial visit. Mean logMAR best corrected visual acuity (BCVA) was 0.28 (20/55) (range: 20/20 to 20/400) at baseline and 0.25 (20/51) (range: 20/20 to 20/400) at last follow-up. Pars plana vitrectomy was performed in 10 eyes (4.1%) for mac- ular hole (six eyes) and increased VMT (four eyes); BCVA was at least 20/40 in eight of the 10 eyes at last follow-up. CONCLUSION: Patients with VMT generally had a fa- vorable clinical course when managed initially by observation. Spontaneous release of VMT occurred in approximately one-third of patients. At last follow- up, pars plana vitrectomy was performed in fewer than 5% of patients. [Ophthalmic Surg Lasers Imaging Retina. 2015;46:571-576.] INTRODUCTION Vitreomacular traction (VMT) is a type of vitreo- macular interface disorder defined as elevation of the cortical vitreous above the retinal surface, but with remaining attachment to the fovea. 1-4 It is a term usu- ally reserved for eyes with symptoms relatable to the macular attachment, and is distinct from the more re- cently coined term of vitreomacular adhesion (VMA), which is often asymptomatic and common, and prob- ably an intermediate stage in the process of posterior vitreous separation. VMT can present with decreased vision, metamorphopsia, and photopsia; however, VMT also can be relatively asymptomatic. VMT can be associated with a variety of anatomic changes to the fovea. Emergence of spectral-domain optical coherence tomography (SD-OCT) has dem- onstrated that incomplete separation of the posterior vitreous with persistent attachment confined to the fovea is relatively common and usually clinically asymptomatic. SD-OCT also provides a tool to moni- tor the extent and progression of VMT. Because the clinical course and natural history of VMT is not well established, the management options are variable and different. The purpose of this study was to examine the clin- ical course of patients with VMT managed initially From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida (JHT, VJJ, HWF, WES); the Dean McGee Eye Institute, Oklahoma City, Oklahoma (JRJ, BAI, AC, RL); Retina Vitreous Associates Medical Group, Los Angeles, California (HT, DSB); the University of Puerto Rico, San Juan, Puerto Rico (MHB); Vitreous-Retina-Macula Consultants, New York, New York (MS, KBF); and the Carolina Retina Center, Columbia, South Carolina (JGG). Originally submitted October 6, 2014. Revision received January 26, 2015. Accepted for publication March 24, 2015. Supported in part by grant P30-EY014801 from the National Institutes of Health and an unrestricted grant from Research to Prevent Blindness to the University of Miami. The authors report no relevant inancial disclosures. Address correspondence to Jonathan H. Tzu, MD, 900 NW 17th Street, Miami, FL 33136; 305-326-6000; fax: 305-326-6417; email: jtzu2@med.miami.edu. doi: 10.3928/23258160-20150521-09