Tractional cystoid macular edema: A subtle variant of the vitreomacular traction syndrome

Purpose: To describe clinical characteristics and treatment outcomes in a series of patients with tractional cystoid macular edema, a subtle variant of the vitreomacular traction syndrome. Design: Retrospective, uncontrolled, observational, and interventional case series. Methods: PATIENT POPULATION: Ten consecutive patients (11 eyes) with multicystoid foveolar thickening caused by localized perifoveal vitreous detachment. EX, PERIMENTAL PROCEDURES: Slit-lamp biomicroscopy and fluorescein angiography; confirmation of vitreomacular relationship with B,scan ultrasonography, optical coherence tomography (OCT), or both. Vitrectomy with peeling of posterior hyaloid in 8 eyes with pretreatment visual acuity <= 20/60. MAIN OUTCOME MEASURES: Visual acuity and resolution of cystoid macular edema at final follow-up. Results: The median age of symptom onset was 71 years (range 48-81 years). Shallow perifoveal vitreous detachment was detectable on biomicroscopy in 8 of 11 eyes (73%) and with ultrasound and OCT in all eyes. Fluorescein angiography revealed no leakage from perifoveal capillaries in 8 eyes (73%). After a mean postoperative follow,up of 26.0 months (range 3-84 months), the final visual acuity had improved by 2 or more Snellen lines and measured 20/40 or better in 8 (100%) of 8 operated eyes. Cystoid foveal thickening resolved in all operated eyes. 0 Conclusion: Subtle, localized perifoveal vitreous detachment may cause anterior traction on the foveola, resulting in multicystoid foveal thickening without macular hole formation or capillary leakage. OCT and ultrasound imaging are useful in detecting the detached posterior hyaloid when clinically invisible. Foveal thickening resolves and visual acuity typically improves after the relief of vitreofoveolar traction.