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Bulgarian Review of Ophthalmology

Pneumatic vitreolysis in the treatment of vitreomacular traction syndrome

Martina Milkovska, Ilian Shandurkov


Introduction: The vitreomacular traction (VMT) syndrome is characterized by an incomplete posterior vitreous detachment with the persistently adherent vitreous exerting tractional pull on the macula and resulting in morphologic and functional changes.

Aim: The aim of this article is to demonstrate our approach and results in the treatment of vitreomacular traction syndrome using intravitreal application of expanding gas, sulfur hexafluoride (SF6), and to discuss the exact indications for success in this type of treatment.

Materials and Methods: Our study included four eyes of four patients with VMT syndrome, diagnosed with optical coherence tomography (OCT), ophthalmoscopy, and visual acuity testing, which have been followed up and treated in the last year. We applied single pars plana intravitreal injection of 0.2 cc 100% SF6 to induce pneumatic vitreolysis. After the procedure we followed up the patients for a period of 3 months.

Results: In two of the eyes, we accomplished posterior vitreous detachment from the macula and termination of the traction forces was achieved. A month after the application we noted an improvement in the visual acuity with an average of 2 lines. Reduction of the central macular thickness was measured by the use of OCT. No complications were observed. In the other two cases, in which there was a densely adherent membrane on a broad base, no therapeutic effect was achieved.

Conclusion: The intravitreal application of expanding gas is minimally invasive, affordable and available treatment of VMT syndrome. In the cases of cystoid macular edema, due to traction from incompletely detached vitreous and in small macular holes, it is a preferable method because of its low cost, minimal side effects, and quick application.


pneumatic vitreolysis, vitreomacular traction, sulfur hexafluoride

Full Text


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About The Authors

Martina Milkovska
VISION Eye Hospital, Sofia

Ilian Shandurkov
VISION Eye Hospital, Sofia