Pneumatic Vitreolysis for Management of Symptomatic Focal Vitreomacular Traction

Pneumatic vitreolysis (PVL) is the intravitreal injection of a small quantity of expansile gas for the purpose of achieving focal vitreomacular traction (VMT) release for eyes with symptomatic VMT, or inducing VMT release and closure of the macular defect for eyes with a small stage-2 macular hole (MH). Initially, there was limited interest in this technique upon its introduction for clinical treatment in human eyes in 1993. With the advent of optical coherence tomography allowing detailed observation of vitreomacular interface changes and rising importance of medical economics in recent years, there has been increasing interest in PVL, a low-cost procedure for managing symptomatic VMT. The success rates of VMT release in the literature have ranged from 60% to 100% and the rates of closure of small macular holes have ranged from 50% to 80% following PVL. In a recent retrospective consecutive series of 56 eyes in two centers undergoing C3F8 gas injection, Chan and Mein reported an overall success of 86% in VMT release and 60% closure of small macular holes with few adverse events (7% with retinal breaks, retinal detachment, or progression of VMT). Multiple recent studies have shown superior outcome utilizing C3F8 gas compared with SF6 gas for PVL. In conclusion, PVL is a promising, low-cost therapeutic option, with the potential for managing symptomatic focal VMT on a global scale.